Summary - The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma -  Bessel Van Der Kolk M D

Summary - The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma - Bessel Van Der Kolk M D


• The book is a tour de force that promises to transform the treatment of Trauma. It offers a fresh and creative perspective on Trauma and its treatment.

• The book will be a classic in psychiatry. It uniquely integrates knowledge from neuroscience, developmental psychopathology, and interpersonal neurobiology. It provides innovative treatment approaches.

• The book describes the most important breakthroughs in mental health in recent decades. It shows how Trauma fragments the mind and breaks connections in the brain and between mind and body. It introduces new approaches to help people overcome Trauma.

• The book shares the author's journey to understand Trauma, the parallel journeys of trauma victims, and the medical disciplines meant to help them. It shows how Trauma divides mind and body, causing social problems. However, it offers hope through new treatments and strategies.

• The author is unparalleled in synthesizing new developments in Trauma. The book articulates new and better therapies based on understanding how Trauma affects brain development and attachment. It provides a moving summary of what we know about Trauma's effects.

• The book is brilliant, compelling, and hard to put down. It articulates new hope for healing chronic Trauma's effects through fostering self-awareness and inner safety.

• The book shows how infants are biological beings that use all their systems to find meaning. It provides insight and guidance for understanding and overcoming the effects of chronic childhood trauma.

• The book eloquently shows how overwhelming experiences shape brain, mind, and body—and how the resulting problems undermine the capacity for love and work. It leads to new therapeutic approaches to "rewire" the brain and help trauma survivors reengage in the present.

• The author is a leader in understanding Trauma's impact and the creative strategies to continue growing despite it. The book helps readers comprehend Trauma's complex effects and guides them to approaches beyond mere survival—to thrive.

The praise highlights how the book synthesizes the latest trauma research and treatment. It articulates new hope for integrating mind and body to overcome Trauma. Moreover, it provides a captivating look at the parallel journeys of patients and clinicians toward understanding and healing from Trauma. The author is seen as the leading thinker in creatively addressing Trauma's effects.

The author, Bessel van der Kolk, has spent his career studying Trauma and its effects on the brain and body. He was drawn to study medicine and the human organism from a young age, fascinated by how the body works. When he began studying psychiatry, he was struck by how little was known about the origins of the problems psychiatrists were treating.

In recent decades, there have been significant advances in neuroscience, developmental psychopathology, and interpersonal neurobiology that have led to an explosion of knowledge about Trauma and its effects. We now know that Trauma causes physiological changes in the brain and body, including a hyperactive alarm system, increased stress hormones, changes in how we filter information, decreased connection with the physical sense of feeling alive, hypervigilance, and difficulty learning from experience.

These discoveries show that the behaviors of traumatized people stem from brain changes, not character flaws or lack of willpower. Moreover, the new knowledge in these fields points to new treatment possibilities to heal Trauma or reduce its effects using the brain's neuroplasticity. The three significant avenues are:

  1. Top-down: Talking about Trauma, connecting with others, understanding what is happening in our minds and bodies, and processing traumatic memories.

  2. Bottom-up: Engaging in activities that access the emotional and sensory parts of the brain, like yoga, theater, and music. This help restores the capacity to be fully alive in the present moment.

  3. Regulating the body: Practices like mindfulness, neurofeedback, and psychotropic medications. This help reset the brain and body regulatory systems that get dysregulated by Trauma.

Overall, the book explores how Trauma shapes the body and brain, and new paths to healing based on cutting-edge knowledge of neuroscience and trauma treatment. The summary gives an overview of the major themes and treatment approaches covered in the book.

The author first encountered the effects of Trauma during his work as a psychiatrist at a Veterans Administration clinic. In 1978, his first patient was a Vietnam veteran named Tom with severe PTSD. Tom had constant nightmares and flashbacks of traumatic events from his time in combat, drank heavily, had anger issues, and felt disconnected from his family.

The author notes that Tom's symptoms were familiar from his childhood. The author's father and uncle, who had survived WWII and internment camps, also had angry outbursts and never discussed their wartime experiences. The author's mother, who had a history of childhood trauma, would faint when asked about her early life.

When Tom first came to see the author, the author focused on treating Tom's nightmares and flashbacks, as that was the aspect of PTSD the author best understood at the time. However, Tom refused to take the medication prescribed, stating that suppressing the nightmares would be like abandoning his fellow soldiers who died in Vietnam.

The author realized that Tom's Trauma was much more complicated than just the nightmares and flashbacks. Tom felt he had to remain haunted by his traumatic memories to honor his lost friends. The author began to understand the deep psychological wounds caused by Trauma.

In summary, the author's encounter with Tom, a Vietnam veteran crippled by severe and unhealed Trauma, gave his first insights into Trauma's profound and long-lasting impacts. Tom's Trauma had disrupted his whole life and existence. The author started recognizing Trauma as a mental health issue requiring specialized treatment.

  • The author works with Vietnam veterans suffering from PTSD. Through his work, he realizes the enormous impact of Trauma on a person's life.

  • He meets Tom, a veteran whose best friend Alex was killed in front of him during an ambush in Vietnam. Tom is stuck in the past and unable to move on from this traumatic experience. The author sees how Trauma has transformed Tom's life.

  • The author looks for resources to understand his patients' conditions but finds little information on PTSD and Trauma. He relies on his observations and discussions with patients to learn more. He finds that Trauma shatters people's lives and sense of self.

  • Tom shares the details of the ambush where Alex died. The Trauma of this experience, and of raping and killing civilians in revenge afterward, has made it impossible for Tom to reconnect with his previous life. The death of his friend felt like the death of part of himself.

  • Trauma makes it very difficult to engage in close relationships due to a lack of trust in oneself and others. Tom continues to meet with the author, who becomes his lifeline. Confronting the shame of Trauma is an enormous challenge.

  • The key takeaway is that Trauma profoundly impacts a person's life, relationships, and sense of self. Overcoming Trauma requires confronting unbearable pain and shame, which is an immense challenge, but it is necessary to start the healing process.

The summary lays out the key elements around the impact of Trauma, using the examples of Tom and other veterans. It captures how Trauma fundamentally changes people in devastating ways but that healing is possible through facing Trauma, though immensely difficult. The core message is hope - people can heal from even the deepest of wounds, though it requires courage, support, and a willingness to confront immense pain.

Here are the key points:

  1. Soldiers who have witnessed or committed horrendous acts during the war often suffer from traumatic shame and guilt. They despise themselves for how they felt and acted during those events.

  2. Victims of child abuse also frequently experience agonizing shame about what they did to survive the abuse. This can lead to confusion about whether they were victims or willing participants.

  3. Tom, a Vietnam veteran, and lawyer, suffered from emotional numbness and felt distant from his loved ones. The only relief was intense involvement in his work, such as an exciting legal case. However, when the case ended, his symptoms returned.

  4. A study on nightmares and Trauma revealed that Trauma could change how people perceive and imagine things. A veteran, Bill, had flashbacks of dying children in Vietnam triggered by his newborn crying.

  5. Tests using inkblots showed that many traumatized veterans imagined traumatic scenes from their past, rather than ordinary images. Some went blank and saw nothing. This showed that their imagination was impaired.

  6. Imagination is critical to the well-being and quality of life. It allows us to fantasize, envision new possibilities, relieve boredom and pain, enhance pleasure, and enrich relationships. However, trauma sufferers are often pulled into the past, impairing their imagination.

  7. The traumatic event is limited, but flashbacks can recur without warning and go on indefinitely. This makes them even more frightening and disturbing.

So in summary, the passage discusses how Trauma can haunt survivors through flashbacks, traumatic shame, damage to imagination, and the ability to perceive the world and relationships in an ordinary, flexible way. Restoring imagination and finding relief from constant re-experiencing of painful past events is crucial to healing.

  • Traumatic experiences can cause a loss of mental flexibility and imagination. Traumatized people tend to perceive the world in a threatening way.

  • The author worked with war veterans who struggled with traumatic memories and had trouble functioning in daily life. Initially, the veterans were misdiagnosed and received inadequate treatment.

  • In 1980, the diagnosis of posttraumatic stress disorder (PTSD) was created to describe the symptoms of trauma victims. This allowed for more research on effective treatments.

  • The author proposed studying the biology of traumatic memories but was rejected. He resigned from the V.A. and took a job teaching psychopharmacology.

  • The author found that many of his female patients reported being sexually abused as children, contradicting the belief that incest was extremely rare. These patients exhibited similar symptoms to those with PTSD.

  • Trauma from war, violent crimes, child abuse, and neglect can be deeply damaging. In the last few decades, we have learned more about how to help trauma victims heal by studying the brain and developing new treatments.

The key points are:

  1. Trauma can fundamentally change how people perceive and respond to the world.

  2. Creating the PTSD diagnosis was crucial to helping trauma victims.

  3. Trauma is widespread and takes many forms beyond exposure to war.

  4. We have gained a much deeper understanding of Trauma and new methods for effective treatment through recent scientific and therapeutic advances.

Does this summary accurately reflect the passage's key ideas and flow of ideas? Let me know if you want me to clarify or expand on any summary part.

In the late 1960s, the author was an attendant in a psychiatric research ward at Massachusetts Mental Health Center. At the time, psychotherapy was the primary treatment for mental illness. However, new antipsychotic drugs were starting to be used, and the ward was conducting research comparing psychotherapy and medication for treating schizophrenia.

The author's role was to organize recreational activities for mostly college-age patients. In conversations at night, many patients confided stories of Trauma, abuse, and neglect in their childhoods. However, in the doctors' discussions of patients during rounds, these traumatic experiences were rarely mentioned or considered possible contributing factors to the patient's conditions. The medical model focused more on managing symptoms than understanding patients' life experiences and sources of distress.

The author questioned the distinction between "hallucinations" reported by patients and possible fragmented memories of actual traumatic events. Research has shown that trauma survivors often report bodily sensations and voices without apparent physical cause. Many patients exhibited violent and self-destructive behaviors, especially when frustrated, thwarted, or misunderstood. The staff was trained to control these situations, sometimes by physically restraining patients.

The author cites the case of Sylvia, a 19-year-old patient who was usually mute and frightened. Her symptoms and history pointed to Trauma, but the doctors attributed her condition to "the ravages of schizophrenia." They did not explore possible connections between her frightening experiences and current state. The author came to believe the system failed Sylvia and many other patients by not recognizing or addressing the role of Trauma in their suffering.

In summary, this passage describes the author's experiences witnessing the transition from psychotherapy to pharmacology in psychiatry in the 1960s. Through conversations with patients, the author came to recognize the prevalence and role of Trauma that was largely overlooked in the medical model of the time. The author questioned the distinctions between symptoms like hallucinations and patients' actual memories. The system failed to adequately understand or help many patients by not recognizing the connections between their traumatic life experiences and mental suffering.

  • The author trained as a psychiatrist at Massachusetts Mental Health Center (MMHC) in the 1970s. Many famous psychiatrists, including Nobel laureate Eric Kandel, had trained or worked there.

  • The author's teacher, Elvin Semrad, emphasized understanding patients' suffering and life experiences rather than relying on diagnostic labels. He taught that healing requires acknowledging bodily and emotional experiences.

  • However, psychiatry was moving toward a biological and pharmacological approach. A 1968 study found that schizophrenic patients treated with drugs alone had better outcomes than those who also received psychotherapy.

  • The author embraced the new psychopharmacological treatments and helped pioneer lithium and Clozaril. These drugs dramatically reduced the number of patients in mental hospitals and improved many patients' lives.

  • However, the drugs did not fully realize the hope of targeting specific brain abnormalities. The push for precision led researchers to develop the Research Diagnostic Criteria, which became the basis for the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM aimed to classify and diagnose psychiatric problems systematically.

  • The 1980 DSM-III acknowledged that the diagnostic system was imprecise and should not be used for forensic or insurance purposes. However, it was increasingly used that way, contributing to a biological model of discrete mental disorders that could be fixed with drugs.

  • The author argues that this model does not reflect the complex realities of human suffering and relationships. A medical approach depends on available technology, but human problems have remained the same. Healing still requires acknowledging life experiences and the body.

So in summary, the author traces the rise of a biological and pharmacological model of psychiatry that depended on the DSM diagnostic system. However, he argues that this model is limited and that human suffering is still rooted in life experiences, relationships, and the bodily experience of emotions. A genuinely healing approach must incorporate those dimensions.

The author became interested in learning more about traumatic stress and PTSD. She attended a conference where she learned about research on dogs subjected to inescapable electric shocks. These dogs had high-stress hormones and learned helplessness levels, similar to humans with PTSD. The author realized that traumatized people often feel trapped and helpless during their Trauma, and have difficulty returning to an average level of arousal afterward.

The author discusses how animals and humans return to familiar places, even if those places are dangerous or frightening. She provides the example of a patient who returned to her violent pimp after escaping him. The author says Freud referred to this as "the compulsion to repeat," though there is no evidence that repetition leads to mastery or resolution.

The author discusses how activities that initially cause fear or pain can become pleasurable over time due to the body adjusting and craving the endorphins released. This may explain why some people are attracted to dangerous or painful situations and relationships. For example, the author cites research showing that most severely wounded soldiers did not ask for morphine, indicating that strong emotions can block pain.

The author and colleagues did a study where they showed combat veterans violent movie clips while measuring how long they could keep their hands in ice water. They found that the veterans could keep their hands in the icy water longer when watching the violent clips, compared to neutral clips, indicating that the violent images increased their pain tolerance. This suggests that traumatized people may become desensitized or even addicted to high arousal levels.

  • In 1985, Bessel van der Kolk learned that serotonin levels in the brain influence how reactive individuals are to threats and stress. Low serotonin is linked to hyperreactivity and difficulty coping socially.

  • In 1988, fluoxetine (Prozac) was released, which increases serotonin levels. Van der Kolk conducted a study giving Prozac to trauma patients and combat veterans with PTSD.

  • The trauma patients improved significantly on Prozac, reporting better sleep, emotional control, and less preoccupation with the past. However, the combat veterans did not benefit from Prozac.

  • Medications like Prozac have helped in treating trauma-related disorders. They help give patients perspective and help control impulses. However, they should only be seen as adjuncts to overall treatment.

  • The rise of pharmacology led to greater prestige and funding for psychiatry but also harmed, as it promoted the idea that mental illness is primarily due to chemical imbalances correctable by drugs. Drugs have displaced therapy for some and allowed the suppression of underlying issues.

  • While medications can provide relief and help with functioning, Trauma ultimately requires dealing with underlying issues. Medications alone deflect from these deeper issues.

In summary, van der Kolk sees medications as potentially helpful but limited tools in addressing Trauma. They should not be seen as primary or sufficient in treatment but rather as adjuncts while patients work to process Trauma in therapy and make more profound life changes. Medications alone will not fundamentally heal from Trauma.

The development of neuroimaging techniques like PET and fMRI in the 1990s allowed scientists to observe the workings of the human brain in new ways. By mapping brain activity during different mental tasks and recalling memories, researchers gained insights into the neural mechanisms underlying conditions like Trauma and PTSD. The author worked with a team that used fMRI to study what happens in the brains of people experiencing traumatic flashbacks. They had volunteers recall and relive fragments of their traumatic memories while in the scanner.

The results showed that during flashbacks, the parts of the brain responsible for emotion (like the amygdala) were highly activated. In contrast, the prefrontal cortex, responsible for rational thinking and judgment, was deactivated. This helps explain the intense emotions and loss of control that characterize flashbacks and PTSD. The study also found that traumatic memories are "imprinted" in the brain and activated by reminders of the Trauma. Neuroimaging has transformed our understanding of Trauma by providing a window into how the brain encodes and retrieves traumatic memories.

The key points are:

  1. Neuroimaging allows scientists to observe the living, working human brain.

  2. A study used fMRI to scan the brains of people experiencing traumatic flashbacks.

  3. During flashbacks, emotional brain regions were hyperactivated, while rational brain regions were deactivated.

  4. Traumatic memories are strongly encoded in the brain and reactivated by trauma reminders.

  5. Neuroimaging has given us a much better understanding of the neural mechanisms of Trauma and PTSD.

The summary encapsulates the key details and main takeaways from the passage on how neuroimaging has provided insights into the trauma-affected brain. Please let me know if you want me to clarify or expand the summary further.

  • Marsha was driving with her young daughter Melissa when her seatbelt alarm went off. As Marsha reached over to fix the seatbelt, she ran a red light, and her car was hit on the right side, killing Melissa instantly. Marsha was pregnant then and lost the fetus on the way to the hospital.

  • The accident left Marsha with severe Trauma and PTSD. She had trouble working with children and had to change jobs. Hearing children laugh would trigger painful memories and flashbacks of the accident.

  • A study using fMRI scans showed that when Marsha heard a recording recreating the sounds from the accident, her brain lit up in areas involved in emotion, fear, and visual memory. However, her brain's speech center decreased activity, showing how Trauma can make it difficult to put experiences into words.

  • The scans also showed that Marsha's brain activity was much higher on the right side during the flashbacks. The right brain is involved in emotion, intuition, and visual-spatial functions. The left brain is more involved in logic, language, and sequencing events. Trauma can sometimes disrupt the connection between the two sides of the brain.

  • With the left brain functioning correctly, it is easier for people to organize their experiences into logical sequences, understand cause and effect, or express themselves verbally. This is why Trauma is often "pre-verbal" and challenging to convey to others through words. Visual images, sounds, smells, and emotions are experienced as fragmented sensory memories.

  • The study showed how Trauma leaves a lasting imprint on the mind and the body. Even over a decade after the event, trauma survivors can relive the fear and distress of the original Trauma. Their bodies react as if the threat is still present, even when consciously, they know they are no longer in danger.

  • Trauma affects the entire body and brain. In PTSD, the body continues to defend against a threat from the past. Healing means ending this stress response and restoring safety.

  • After Trauma, the world is experienced differently due to changes in the nervous system. Survivors focus on suppressing inner chaos, limiting spontaneous involvement in life. This can lead to physical symptoms like chronic fatigue or fibromyalgia.

  • Treatment must engage the whole body and brain. The body's response to threat involves multiple systems:

  1. The amygdala activates the stress response, releasing cortisol and adrenaline. The body goes into fight or flight.

  2. The hippocampus is involved in context and episodic memory. Its function is inhibited, narrowing awareness to focus on the threat.

  3. The prefrontal cortex involves thinking, judgment, and self-awareness. Its function is impaired, limiting awareness of the present and the ability to self-calm.

  4. The vagus nerve links the guts and brain. Its tone reflects anxiety and stress, and it prompts social engagement. Its function is disrupted.

  5. The body mobilizes with increased heart rate, blood pressure, startle reflex, and muscle tension. However, this response is brutal to turn off, becoming the new normal state.

  6. Social engagement is impaired. Trust, intimacy, and relationships are affected. However, relationships can also foster healing.

This organized response to threat worked well for human survival, but after chronic Trauma, it can become the default and inflexible mode of being. Treatment helps overcome these survival-based patterns to restore well-being. The body and mind can return to balance, reengaging with life in the present. Relationships and trust can be rebuilt. A sense of safety and aliveness can be reclaimed.

  • Our brain has evolved in layers from the bottom up. The oldest part is the reptilian brain which controls essential life functions like breathing, heart rate, balance, etc.

  • Above that is the limbic system or mammalian brain, which is responsible for emotions, memory, social behaviors, etc. It develops rapidly after birth and is shaped by early experiences. Positive experiences lead to brain circuits specialized in play and cooperation. Negative experiences lead to circuits specialized in fear and abandonment.

  • The limbic system and reptilian brain together make up the emotional brain. It monitors for threats and alerts us by releasing hormones that produce visceral sensations. It makes snap judgments based on rough similarities. It initiates preprogrammed responses like fight or flight.

  • At the top is the neocortex or rational brain. It is responsible for higher-order thinking, planning, and understanding the outside world. It makes up only 30% of the brain.

  • The emotional brain is faster but more primitive. The rational brain is slower but more sophisticated. The emotional brain can partially shut down the rational brain during threats. However, for the most part, the different parts of the brain work together, with the emotional brain closely monitoring the internal state and the rational brain figuring out how to satisfy needs and accomplish goals.

  • Psychological problems arise when there are issues with sleep, appetite, arousal, digestion, relationships, etc. Effective treatment must address the body's essential functions in addition to thoughts and behaviors.

The frontal lobes develop rapidly in the second year of life. They are responsible for qualities that make us uniquely human, such as using language, complex thinking, planning, creativity, and empathy. The frontal lobes allow us to control impulses, predict the consequences of actions, and choose appropriate behavior.

The brain has a "bottom-up" development, with more primitive parts developing first. The reptilian brain controls essential functions. The limbic system, including the amygdala, develops mainly in the first six years of life, and is responsible for detecting threats. The frontal lobes develop last. Trauma can impact the development and functioning of all parts of the brain.

The thalamus acts as the "cook" in the brain, integrating all sensory input into a coherent experience of what is happening. It sends information to the amygdala and frontal lobes. The amygdala is the "smoke detector," quickly detecting threats before we are consciously aware. If it senses danger, it triggers a stress response to prepare us to fight or flee. The frontal lobes, especially the medial prefrontal cortex, act as the "watchtower," helping determine if the threat is real and regulating the stress response.

Trauma can lead to misinterpreting threats and losing control over the stress response. The amygdala may overestimate threats, while the frontal lobes have trouble filtering out irrelevant information and calming the stress response. This can make people feel agitated, aroused, and unable to gauge the intentions of others. Treatment often focuses on improving frontal lobe functioning to help regulate emotions and the stress response.

  • The amygdala is the emotional brain's smoke detector that detects threats and triggers the fight or flight response. The prefrontal cortex is the rational brain's watchtower that can evaluate the threat and determine an appropriate response.

  • In PTSD, the amygdala and prefrontal cortex balance shifts, making it harder to control emotions and reactions.

  • Dealing with stress requires balancing the emotional (amygdala) and rational brain (prefrontal cortex). This can be achieved through top-down regulation using mindfulness or bottom-up regulation using breathing, movement, and touch.

  • The metaphor of the rider and the horse illustrates the relationship between the rational and emotional brains. When there are no threats, the rider (rational brain) is in control. However, the horse (emotional brain) takes over in threatening situations, and the rider tries to hold on.

  • Two examples show how Trauma can lead to the timeless reliving of memories and dissociation:

  • Stan and Ute were in a severe car accident and relived the traumatic experience for months after, unable to sleep or stop intrusive thoughts about the accident.

  • fMRI scans while reliving the Trauma showed Stan's emotional brain was highly activated, as if he was experiencing the accident again in the present moment. This demonstrates how in PTSD, traumatic memories are relived rather than just remembered.

The key points are:

  1. Achieving a balance between the emotional and rational brain is critical to managing stress and emotions.

  2. In PTSD, the balance between the emotional and rational brain is disrupted, making it hard to control reactions and emotions.

  3. Reliving traumatic memories and dissociation are hallmarks of PTSD that demonstrate how the emotional brain remains stuck in the past traumatic experience.

  4. Both top-down (mindfulness) and bottom-up (breathing, movement) strategies can be used to restore the balance between the emotional and rational brain.

The unresolved Trauma continues to activate the body's stress responses and triggers defensive reactions and intense emotions as the events of the Trauma are repeatedly replayed in mind. This causes a vicious cycle where the traumatic memories become more strongly encoded, worsening symptoms.

Many people with PTSD are unaware of the connection between their symptoms and the traumatic event. They do not understand why they overreact to minor stressors as if facing a life-threatening situation. Flashbacks and reliving the Trauma can be even more distressing than the actual event because they occur unpredictably. People organize their lives around avoiding triggers that might cause flashbacks.

If not addressed, PTSD causes changes in brain function and structure. The region involved in threat detection, the amygdala, becomes overly activated, while the prefrontal cortex that regulates emotions and the thalamus that filters sensory information becomes underactive. This results in hyperarousal, difficulty controlling emotions, and sensory overload. The loss of connection to the present moment and sense of time causes intense distress.

Therapy aims to help people gain awareness of their internal experiences, learn to regulate emotions, and process traumatic memories within a context of safety and control. As brain function normalizes, symptoms improve. The key is to address the past Trauma while staying grounded in the present.

Ute had a very different reaction in the brain scanner. Instead of reliving the Trauma, she showed signs of depersonalization - a sense of detachment from herself, her emotions, and her surroundings. This is another way the brain copes with overwhelmingly distressing events. The areas of her brain involved in self-awareness and autobiographical memory were deactivated, allowing her to distance herself from the Trauma. While this defensive mechanism may have helped her survive then, it is maladaptive in the long run. Therapy needs to focus on safely reconnecting her with her inner experiences.

Overall, the findings show how Trauma disrupts brain networks involved in memory, emotion regulation, self-awareness, and sensory processing. Targeted therapies can reverse these effects only when people stay focused on the present moment. The past can only be healed by living fully in the present.

  • Charles Darwin explored the biological basis of emotions and their expression in his work The Expression of the Emotions in Man and Animals. He saw emotions as vital for motivating behavior and human and animal survival.

  • Darwin noted that humans and other mammals share similar organs, senses, instincts, and emotions. We also display some of the same physical expressions of emotion, like raising hackles or baring teeth. These are remnants of our shared evolutionary past.

  • For Darwin, emotions originate in biology. They drive behavior and are expressed primarily through facial expressions and body movements. These expressions communicate our emotional state to others, serving purposes like warning others off, attracting care, signaling alarm, etc.

  • Darwin saw that prolonged survival-oriented behavior and avoidance could be maladaptive, as it takes away from other functions necessary for species survival, like feeding, shelter, mating, and reproduction. In humans, being "stuck in survival mode" can inhibit nurturing relationships, imagination, planning, play, learning, and attending to others' needs.

  • Darwin discussed the intimate connections between the heart, gut, and brain. Strong emotions impact the body, and the body's state impacts the mind. Feeling emotions viscerally, in the chest or gut, can be unbearable and drive unhealthy coping behaviors as people try to escape the sensations.

  • The key points are that Darwin saw emotions as biologically based, expressed physically, connected to survival instincts, and involving tight connections between mind and body. Prolonged survival-oriented emotions and behaviors can be maladaptive. Moreover, visceral feelings of emotions can be intolerable and drive unhealthy coping strategies.

• Our emotions are linked to the physical sensations in our body. Understanding this mind-body connection is vital in helping people recover from Trauma.

• The autonomic nervous system (ANS) regulates our physical arousal and comprises two branches:

  1. The sympathetic nervous system (SNS) activates the fight or flight response. It increases heart rate, blood pressure, etc.

  2. The parasympathetic nervous system (PNS) activates the rest and digest response. It decreases heart rate, blood pressure, etc.

• The polyvagal theory explains how our social connections and environment impact our physiology. Feeling safe with others calms our nervous system; feeling unsafe activates it.

• Safety and reciprocity are fundamental to well-being. Trauma impairs people's ability to connect with others and feel safe. Treatment should focus on restoring the capacity for safe social engagement.

• There are three levels of safety:

  1. Biological safety: Ability to regulate arousal and bodily sensations. It is achieved through breathing, meditation, etc.

  2. Emotional safety: Ability to connect without feeling fearful or helpless. It is achieved through reciprocal relationships.

  3. Psychological safety: Ability to understand one's own reactions and behaviors and maintain a stable sense of identity. It is achieved through talk therapy, art therapy, etc.

• Building safety at these levels helps to reset a traumatized nervous system so people can experience relaxation, joy, and intimacy again. Treatment should incorporate social support, mindfulness, and psychotherapy.

• Relationships with animals can also help restore a sense of safety when human connection is too threatening. This is the basis for animal-assisted therapy.

That covers the key points about using mind-body techniques and relationships to help people recover from Trauma. Please let me know if you want me to clarify or expand on any summary part.

  • People react differently to traumatic events: some remain focused and calm, some panic and become frantic, while others collapse mentally and become unresponsive.

  • According to Porges's theory, our autonomic nervous system has three states: social engagement (call for help), fight or flight (defend ourselves), and collapse (shutdown to conserve energy). The level of safety determines which state is activated.

  • The vagus nerve and its branches control these three states. The ventral vagal complex (VVC) activates the social engagement system, slowing the heart and breathing. The sympathetic nervous system activates fight or flight, increasing heart rate and breathing. The dorsal vagal complex (DVC) activates the collapse state, slowing the heart and reducing metabolism.

  • Fight or flight mobilizes us to defend against threats, while the collapse state causes us to become unresponsive to the environment. The collapsed state is a last resort when fighting or fleeing is impossible. The ancient reptilian part of the brain controls it.

  • The VVC evolved to promote social interaction and bonding in mammals. It helps synchronize individuals and fosters pleasure and safety. Trauma impairs the VVC, preventing the social connection.

  • The VVC develops in infants through interaction with caregivers. This helps infants learn to regulate their arousal and connect socially. Disruption of this development can lead to Trauma and problems with arousal regulation or connection.

  • Mammals tend to be on guard, but social interaction requires temporarily reducing vigilance. Trauma can lead to either hypervigilance that prevents enjoyment and connection, or numbness that reduces alertness to threats.

  • The ACE study found that early Trauma increases vulnerability to further Trauma later in life. This may be due to impairment of the body's natural vigilance systems.

  • Sherry grew up in a neglectful and emotionally abusive environment. Her mother frequently told her she did not belong in the family.

  • Sherry was kidnapped and raped for five days in college. When she called her mother for help, her mother refused to speak to her.

  • Sherry engages in skin-picking to relieve feelings of numbness and make herself feel alive, though it also leaves her feeling ashamed. She has seen many therapists, some of whom involuntary hospitalized her.

  • Sherry's skin-picking is a coping mechanism she developed in response to chronic neglect and trauma, not suicidal behavior. She never learned healthy ways of regulating her emotions or seeking support.

  • Sherry began seeing a massage therapist in addition to her therapy with the author. During her first massage, Sherry panicked upon realizing the therapist had moved away, demonstrating her difficulty trusting others and hypervigilance.

  • The author concludes that people like Sherry who engage in self-harm often do so to self-soothe in the absence of supportive relationships, not due to suicidal intent. Their behaviors stem from a lack of learning healthy coping strategies.

Sherry had a history of childhood trauma and neglect. As a result, she had become disconnected from her body and senses. She engaged in destructive behaviors like picking at her skin, but understanding why she did this did not help her stop.

The author discovered that many of her patients with Trauma could not feel parts of their bodies or identify objects placed in their hands. Our ability to do this requires integrating information from different senses, but these connections can break down in traumatized people.

A study found that in people without Trauma, the "default state network" in the brain activates areas involved in self-awareness and a sense of personal relevance when the mind is not focused on anything in particular. However, these areas showed little to no activation in people with chronic childhood trauma. They had learned to shut down the areas that transmit emotions and physical sensations in order to avoid feeling terror. However, this also impaired their ability to experience emotions and sensations that create a sense of self.

As a result, traumatized people may have trouble making decisions, following advice, or even recognizing themselves in a mirror. Therapy and practices that help reactivate the self-sensing system can be helpful. For Sherry, massage therapy, social interaction, and group activities like joining a choir helped improve her self-awareness and quality of life.

The neurologist Antonio Damasio has shown the importance of integrating the sense of self and the body. The "screen" in our mind can hide our inner physical states from our awareness. However, reconnecting the mind and body is crucial to recovery from Trauma.

Here is a summary of the key points:

• Our sense of self and ability to regulate our emotions depends on the constant feedback from our physical sensations and gut feelings. The brain monitors the body and the environment to maintain homeostasis and a sense of equilibrium.

• Traumatic experiences can override the brain's equilibrium, leaving people with threat perception and intense physiological arousal. They have difficulty trusting and making sense of their inner sensations and gut feelings.

• "Agency" refers to the feeling of having some control over your life and circumstances. It starts with awareness of your subtle sensory and body-based feelings—your interoception. The more you can observe your inner states, the more you can regulate your emotions and shape your situation.

• Trauma therapy helps people regain a tolerable awareness of their gut feelings and inner sensations. This aids them in completing the physical responses that were thwarted during the traumatic experience, which helps restore a sense of control and mastery over their inner states.

• Learning to observe your inner sensations without judgment or attempts to control them leads to an ability to respond flexibly based on accurate information from your gut feelings. This helps create a sense of safety in your body and gives you resources to meet life's challenges with imagination and wisdom.

• Attempts to ignore or numb inner warning signs can lead to a fear of fear itself and a tendency to alternate between shutting down and panic. Mindfulness practices help overcome this fear by fostering a curious, open awareness of inner experience.

• Our gut feelings provide a sense of what is safe or threatening, sustaining or depleting. Accurately reading these signals helps us feel secure in ourselves and confident in meeting what each new moment presents.

  • Fear and Trauma feel visceral, like being "scared stiff" or "frozen in fear." The body goes numb and collapses. These physical sensations drive the experience of fear and terror. Until these sensations change, people remain hostage to fear.

  • Ignoring or distorting the body's messages means being unable to detect real danger or what is safe and nourishing. Self-regulation depends on a friendly relationship with your body. Without it, people rely on external sources like medication, alcohol, constant reassurance, or complying with others.

  • Many trauma victims develop physical symptoms without medical cause, like migraines, asthma, back pain, etc. This is because they suppress inner distress signals, although stress still mobilizes their body.

  • "Alexithymia" means having no words for feelings. Many trauma victims cannot identify or describe their feelings or physical sensations. They appear angry or scared but deny those emotions. This makes self-care difficult. They act rather than talk about emotions. They see emotions as physical problems, not signals needing attention.

  • Depersonalization means losing your sense of self. It is common during Trauma. The world seems strange, distant, and dreamlike. Emotions and physical sensations are dulled. Trauma victims feel separated from their bodies.

  • Trauma victims recover by becoming familiar with and befriending their body sensations. Their bodies remain on guard until they can relax and feel safe. Changing requires awareness of sensations and learning to interpret them. Therapy should focus on linking physical sensations to emotions so people can better protect themselves.

The summary covers the key points around how fear and trauma manifest in the body, problems that arise from ignoring or being unaware of bodily sensations, the conditions of alexithymia and depersonalization, and steps to recovery. The assistant identifies the most important details and ideas while condensing the message.

• The author studied 12 traumatized children from an inner-city clinic and compared them with a control group of children from a nearby school matched in age, race, intelligence, and family background.

• The traumatized children had suffered severe physical, sexual, and emotional abuse within their families. Despite living in a violent area, the control children had not suffered such extreme Trauma.

• The researchers used test cards developed specifically for children based on magazine pictures. While the control children told relatively benign stories about the pictures, the traumatized children produced gruesome and violent tales.

• Telling these stories caused the traumatized children to become very disorganized and upset. The researchers had to take breaks to help the children calm down and reorient themselves.

• This study showed that the traumatized children perceived the world as much more frightening and dangerous than the control children with similar life experiences. Their Trauma had severely distorted their view of reality.

• The violent stories seemed to reflect the children's experiences of abuse and neglect. Their interpretations of the pictures provided a window into their inner worlds.

The key findings were that the chronically traumatized children perceived the ambiguous pictures in extremely threatening ways and became disorganized when recounting violent stories about them. This suggests that Trauma had severely distorted their view of the world and ability to regulate their emotions. Their stories reflected their traumatic experiences, providing insight into their inner reality.

In summary, the study illustrated how the inner world of chronically traumatized children could become filled with fear, danger, and violence, which shapes their perceptions and ability to function. Their traumatic experiences left them with a legacy of terror and loss of emotional control.

  • The researchers showed innocuous images to abused and non-abused children to assess their reactions. The abused children had alarming responses, perceived danger, and threat, and became distressed. The non-abused children had regular, trusting responses and imagined benign narratives for the images.

  • The researchers concluded that abused children see the world as threatening due to traumatic experiences. Their behavior made sense in this context. However, their medical records focused on diagnoses like ADHD and oppositional defiant disorder rather than the root cause of their Trauma.

  • The researchers were inspired by John Bowlby and other psychiatrists who studied attachment and the role of mothers. These psychiatrists were often separated from their mothers at a young age, motivating their interest in the topic. Bowlby found that children's behavior depends on their experiences, not fantasies. He developed attachment theory.

  • According to attachment theory, infants have an inborn capacity to bond with caregivers and prefer one or a few primary attachments. The responsiveness of the caregiver determines the security of attachment. Secure attachment gives children a "secure base" to explore the world and develops qualities like empathy, impulse control, and motivation.

  • Attachment depends on emotional attunement from caregivers. Attunement involves subtle physical and verbal interactions that make babies feel understood. Mirror neurons facilitate attunement and empathy. Securely attached babies learn emotional regulation and how to attune to others. They develop supportive relationships and cope well with stress. Insecurely attached babies struggle in these areas and may have behavior issues or trauma symptoms.

  • The researchers aimed to determine if normal children's secure attachment and view of the world could account for their resilience. They also wanted to know if it was possible to help abused children develop a secure attachment and a more trusting worldview.

Here is a summary of the key points:

  1. Infant-caregiver attunement is essential for healthy development. It allows infants to regulate their emotions and physiological states. Lack of attunement can lead to difficulties with self-soothing and emotional regulation later.

  2. Secure attachment in infancy forms the basis for lifelong emotional security and healthy relationships. Securely attached children learn to understand situations where they need help and where they can take control. They become adept at reading social cues and attuning to others.

  3. Insecure or disorganized attachment in infancy can lead to difficulties managing distress, impaired social skills, and mental health issues. Abused or neglected children may become hypervigilant to anger or distress in others and react defensively. They struggle to form close relationships and often feel alienated or disconnected.

  4. The need for attachment is lifelong. People will go to great lengths to feel connected to others in healthy or unhealthy ways. Lack of attachment can lead to feelings of irrelevance and disconnectedness.

  5. Their primary caregivers shape a child's early attachment style. Although children have the instinct to attach, the quality and security of attachment depend on the availability and responsiveness of parents and caregivers. Children develop coping styles to meet their needs in their environment as best.

  6. Assessment tools like the Strange Situation can determine a child's attachment style based on their responses to separation from and reunion with caregivers. Securely attached children show distress upon separation but can be soothed upon reunion. Insecurely attached children have a more challenging time being soothed and may avoid or be ambivalent toward the caregiver.

In summary, early attunement experiences with caregivers shape a child's ability to regulate themselves, form close relationships, and feel secure and connected. Attachment quality depends on the caregiver's availability, responsiveness, and sensitivity. Children adapt as best they can to the parenting they receive, for better or worse.

Here is a summary:

  • Securely attached children have learned that their caregivers will respond to their needs, so they can explore the world freely and return for comfort when needed. Anxious and avoidant children have inconsistent caregivers and adapt by either clinging to their mothers or ignoring them.

  • Disorganized children have caregivers who are frightened or frightened, so they cannot figure out an organized strategy. They seem confused and upset and have trouble regulating their emotions. Disorganized attachment is linked to Trauma and abuse.

  • About 15% of children have a disorganized attachment style. While parents inevitably make mistakes, the key issue is whether children feel viscerally safe. Disorganized children often feel unsafe and may develop behavioral or emotional problems.

  • Disorganized attachment and Trauma are interconnected. Children of traumatized parents are more likely to develop PTSD or other problems after a traumatic event. How parents respond to a child's Trauma also shapes the child's reaction and recovery.

  • Feeling unsafe and lacking attuned care in infancy can lead to lifelong difficulties regulating emotions and coping with stress. Early attachment experiences have lasting impacts on psychology and even physiology. With support, parenting quality can improve, and attachment styles can become more secure. However, early problems may still require treatment to overcome.

The key factors that shape a child's attachment and ability to cope with Trauma are the attunement, safety, and responsiveness provided by their early caregivers - especially their mothers. While parenting is challenging for all, disorganized attachment and Trauma, tend to stem from more severe difficulties that often warrant professional support. With the right help and resources, children and parents can heal and grow in their ability to feel and be safe, connected, and cared for.

  • People with disorganized attachment in childhood have trouble distinguishing between safety and danger as adults and are prone to dissociation.

  • Disorganized attachment is linked to maternal emotional withdrawal, role reversal, and misattunement in infancy. This impairs the child's sense of inner reality and ability to self-regulate.

  • Dissociation is a coping mechanism where one simultaneously knows and does not know one's experiences. It is linked to feeling lost, empty, trapped, and disconnected.

  • Disorganized attachment and dissociation often lead to an unstable sense of self, impulsivity, anger, and self-harm in adulthood. While Trauma plays a really, caregiving quality is most critical.

  • Healing involves addressing impacts of both Trauma and impaired early attunement. Approaches include improving rhythmicity, reciprocity, sensory integration, and learning to feel safe in relationships.

  • The "night sea journey" is a painful process of reclaiming disavowed parts of oneself. One must "exile nothing" and face Trauma, grief, and unmet needs.

  • The case study shows how past abuse and role reversal with caregivers can make relationships feel entrapping as an adult. Trust and healthy intimacy are difficult. The desire to flee relationships alternates with longing for connection.

  • Healing this attachment pattern requires facing Trauma, building self-compassion, setting boundaries, and learning to recognize healthy relationships. It is a long journey that may involve slips backward, but growth is possible.

Marilyn was terrified of intimacy and could not remember much of her childhood before age 12. She exploded in rage when a man touched her accidentally while sleeping, indicating unprocessed Trauma. From her family portrait, it was clear she had endured abuse, though she claimed to have had a happy childhood. The therapist took things slowly, referring her to a group therapist before pushing her to discs of trauma detailsrauma.

Marilyn then began having vision problems and dizziness, which turned out to be an autoimmune disease. The therapist suspected this could be related to unprocessed Trauma based on other patients. A study of incest survivors and controls found that the incest survivors had an abnormality in their immune system that made them oversensitive to perceiving threats.

The therapist concluded that severe Trauma in childhood impacts one's ability to feel safe and distinguish danger from safety. Marilyn's inner map of the world and sense of self were marked by the contempt and humiliation of her abuse. She was more prone to accept mistreatment as familiar. Unlocking the secrets of her past Trauma would be a gradual process.

Marilyn had a deeply ingrained worldview that was shaped by traumatic experiences in her childhood. She believed that men could not be trusted and were selfish, that women were weak, and that the world was fundamentally threatening. This manifested in her suspicious and distrustful behavior towards others.

Marilyn's therapist initially tried to challenge her irrational beliefs, but a fellow group member, Kathy, taught him that he needed to help Marilyn reconstruct her inner map of the world. Our earliest experiences with caregivers shape how we perceive the world, and though these inner maps can be modified, rational arguments are not enough. Change requires reorganizing emotional brain circuits.

Marilyn began recognizing that her assumptions were not universal when a friend confronted her about her behavior. She started therapy, where she learned techniques to regulate her emotions and stay present rather than being hijacked by feelings. She began to access traumatic memories, recovering flashes of the wallpaper in her childhood room. She realized she had repressed memories of being raped by her father at age eight. Her mother did not protect her.

Marilyn had lived with the aftereffects of this Trauma, though her conscious mind lacked the entire narrative. Her body and emotions kept the score. Recovering the memories while learning to manage the intense feelings helped Marilyn start to heal from her childhood trauma.

The critical steps in Marilyn's progress were:

  1. Recognizing her ingrained beliefs and behavior patterns stemmed from childhood trauma

  2. Learning emotional regulation and mindfulness techniques to stay present

  3. Gradually accessing and reconstructing her traumatic memories

  4. Gaining awareness that the Trauma was in the past, and she was now an adult safe from that threat

  5. Starting to form a coherent narrative of what had happened to her as a child

With time and continued work, Marilyn was able to heal from her past, gaining a more balanced view of herself, relationships, and the world.

  • Marilyn's mother did not protect her from her abusive father and instead scolded Marilyn for angering him. Marilyn felt helpless and blamed herself.

  • Childhood sexual abuse depends on silencing and disbelief of the child. Children cannot escape their families and have no choice but to survive. They remain loyal to their families even when abused.

  • Marilyn hated being home but had nowhere else to go. She felt rage, helplessness, loneliness, and despair. She redirected her rage against herself through depression and self-hatred.

  • Marilyn had trouble trusting and attaching to others. Opening up made her feel in danger. She felt unworthy of care, and seeking help would only lead to more hurt.

  • Marilyn's traumatic memories returned in flashbacks, panic attacks, and nightmares. She re-experienced sensations of being choked and unable to breathe. The memories had no coherence or context, only terror.

  • Marilyn showed a strong will to survive and heal from her Trauma despite the immense difficulties. Her therapist was in awe of the life force that allowed her endurance and recovery.

  • The summary outlines how child sexual abuse depends on silencing the child, how this leads to self-blame and lack of trust, how traumatic memories return fragmented, and how the will to heal is so powerful. It focuses on Marilyn's experiences as an example of the themes.

  • Patients with histories of childhood trauma often receive multiple unrelated diagnoses and ineffective treatments. Correctly diagnosing and understanding their condition is critical to providing helpful care.

  • Marilyn, Mary, and Kathy are examples of patients with chronic Trauma who have likely received many different diagnoses and treatments that do not effectively help them.

  • The Diagnostic and Statistical Manual of Mental Disorders (DSM) aims to define mental illnesses precisely but has limitations, especially for complex trauma-related conditions. Diagnoses can have severe consequences and influence a patient for life.

  • The authors conducted a study to investigate the relationship between childhood trauma and borderline personality disorder (BPD). They designed an interview called the Traumatic Antecedents Questionnaire (TAQ) to gather sensitive information about patients' trauma histories.

  • The TAQ started with fundamental questions about patients' current lives and gradually progressed to more revealing questions about their childhood experiences, relationships, safety, discipline, and family environment. Many patients revealed experiences of neglect, abuse, instability, and a lack of affection or safety.

  • After conducting interviews, the authors found a strong relationship between childhood trauma and BPD. The symptoms of BPD, like clinging behavior, emotional instability, and self-harm, seemed to originate as coping mechanisms for overwhelming emotions and inescapable abuse.

  • A proper diagnosis and understanding of the roots of patients' conditions are necessary to provide effective treatment and help. The standard DSM diagnoses and treatments were not helping patients like Marilyn, Mary, and Kathy.

The key points are:

  1. Childhood trauma is often overlooked or misdiagnosed.

  2. Patients can receive many incorrect diagnoses and treatments that do not help them.

  3. The TAQ was designed to properly assess childhood trauma histories.

  4. There is a strong link between childhood trauma and BPD.

  5. Effective treatment must address the underlying Trauma.

  • The author and colleagues conducted a study showing that 81% of patients diagnosed with borderline personality disorder reported severe childhood abuse or neglect. This suggested that the impact of Trauma depends on the age at which it begins.

  • Follow-up research showed that different forms of abuse impact different brain areas at different stages of development. Although many studies have confirmed these findings, some papers still question the link between childhood trauma and borderline personality disorder.

  • The author argues that when children feel angry, guilty, or abandoned, it is usually due to their experiences, not their urges. Bowlby showed that denying powerful experiences leads to problems like distrust, inhibited curiosity, and feelings of unreality.

  • The author's study showed that a history of childhood sexual and physical abuse predicted repeated suicide attempts and self-harm. Inflicting self-harm may start as an attempt to gain control.

  • Their research found that patients who lacked early memories of feeling safe were less likely to benefit from therapy. If people lack memories of feeling loved as children, their brains may not develop the capacity to respond to kindness.

  • Their research led them to propose a new diagnosis, "disorders of extreme stress, not otherwise specified," or complex PTSD. This was to distinguish the symptoms of child abuse victims from those with PTSD from single traumatic events. However, this diagnosis was not included in the DSM-IV, preventing accurate diagnosis and treatment.

  • A study by Vincent Felitti found a strong association between adverse childhood experiences like abuse and health problems. For 10 adverse childhood experiences, the risk of attempted suicide went up by 230-1200%.

  • The author argues that the consequences of child abuse are vast but overlooked. The DSM continues to fail victims of child abuse by not recognizing complex PTSD as a diagnosis.

  • Vincent Felitti treated an obese woman who lost a lot of weight but then rapidly regained it. Upon probing, he found that she had a history of childhood sexual abuse by her grandfather.

  • Felitti then surveyed patients and found that many obese people had experienced adverse childhood experiences (ACEs) like abuse, neglect, household dysfunction, etc. He conducted an extensive study with Kaiser Permanente and the CDC called the ACE study.

  • The ACE study found that ACEs were very common, even among middle-class people. As the number of ACEs increased, so did the risks for health and social problems. People with higher ACE scores were more likely to have learning/behavioral problems, health issues, alcoholism, depression, suicide attempts, drug use, obesity, promiscuity, etc.

  • Felitti realized that for some people, obesity and other issues might be a "solution" to cope with past Trauma and adversity. Losing weight could lead to new psychological issues emerging. For example, the woman regained weight after becoming suicidal, and some men remained obese to appear intimidating.

  • The ACE study showed how interrelated adversities are and how they can have lifelong impacts on health and well-being. However, these impacts often remain "hidden" behind issues like obesity that are mistakenly viewed as the primary problem. In reality, obesity may be a coping mechanism for past Trauma.

  • Felitti argues that we need to address the root causes of health issues and not just treat the surface-level issues or symptoms. Otherwise, treatment is likely to fail, and other problems may emerge.

  • The person overate as a child to feel safe from bullying and abuse. Obesity provided a sense of protection.

  • Many unhealthy behaviors that start as coping mechanisms in childhood persist into adulthood even after the initial cause is gone. They are hard to change because they serve an essential purpose, even if it is only temporary.

  • Child abuse has substantial societal costs but has not received the same public health attention as smoking. Ending child abuse could drastically improve public health.

  • Three case studies show children with severe issues from Trauma, abuse, and neglect. Their diagnoses are many and various but do not capture the underlying problems.

  • It is too simplistic to blame these children's problems solely on "bad genes." Genes interact in complex ways and are influenced by life experiences, especially in early childhood. Trauma can alter gene expression.

  • Developmental trauma disorder is a proposed diagnosis to capture the impact of early childhood maltreatment and better direct treatment. However, it is not officially recognized.

  • Hundreds of thousands of children suffer from the impacts of abuse, neglect, Trauma, and unstable caregiving. However, they are poorly understood and supported.

Epigenetics studies how life experiences can alter gene expression without changing the DNA sequence. Experiments show that rat pups that receive more attentive grooming from their mothers develop biologically and behaviorally differently than pups that receive less attention. Researchers found similar epigenetic effects in humans, such as children whose mothers experienced extreme stress during pregnancy and children who were abused.

The work of Stephen Suomi studying rhesus monkeys provides insight into how nature and nurture interact. He identified monkey personality types that were biologically different and prone to behavioral problems. However, when these monkeys were raised in supportive environments, they developed normally. Monkeys raised with peers rather than mothers became abnormally fearful and anxious, showing that early experiences shape development.

Suomi also found that the effect of a serotonin gene variant depends on the environment. Monkeys with a "risk" variant behaved normally when raised by an adequate mother but became aggressive risk-takers when raised with peers. Similarly, the research found that the variant was linked to depression in humans only in those with a history of abuse or neglect. This shows that nurturing environments can protect against genetic risks.

The National Child Traumatic Stress Network was established in 2001 to promote research on childhood trauma and educate professionals who work with traumatized children. The organization grew out of a recognition that, while much was known about the impact of Trauma on child development, this knowledge was not systematically spread. The Network aims to address this gap to serve traumatized children better.

In summary, epigenetics and studies of nature and nurture in humans and monkeys show that early experiences profoundly shape development by influencing how genes are expressed. Supportive environments can help overcome biological risks, while adverse experiences may lead to problems without risks. Organizations like the National Child Traumatic Stress Network work to spread knowledge about the impacts of childhood trauma to improve services for traumatized children.

  • The National Child Traumatic Stress Network (NCTSN) consists of over 150 centers across the U.S. focused on treating childhood trauma.

  • A survey of nearly 2,000 children in the NCTSN found that most came from dysfunctional families and had experienced emotional abuse, neglect, loss of caregivers, domestic violence, or sexual/physical abuse.

  • The PTSD diagnosis has been beneficial for treating Trauma in adults, but it does not capture the range of issues seen in children with complex Trauma. 82% of children in the NCTSN do not meet the criteria for PTSD.

  • The NCTSN proposed a new diagnosis of Developmental Trauma Disorder to describe children who have experienced ongoing Trauma and disrupted attachment to caregivers. These children show severe problems with emotional regulation, impulse control, cognition, dissociation, relationships, and self-image.

  • The proposed diagnosis of Developmental Trauma Disorder would give these children a single diagnosis to capture their issues rather than multiple diagnoses. It locates the cause of their issues in the trauma and attachment problems they have experienced.

  • The NCTSN submitted a proposal for Developmental Trauma Disorder to the American Psychiatric Association (APA) in 2009, arguing that the current diagnostic system ill-serves these children. They also got support from mental health commissioners across the U.S.

  • The author felt confident the APA would seriously consider the proposed diagnosis given this support.

The researchers conducted a longitudinal study following 180 children for 30 years to understand the impact of early experiences on development. They found that the quality of early caregiving was the most important factor shaping a child's development. Insensitive, neglectful, or harsh caregiving led to problems with emotional and behavioral regulation and relationships. However, early positive experiences and secure attachment to caregivers built resilience.

A separate longitudinal study followed 84 sexually abused girls and 82 non-abused girls for 20 years. The researchers found that the abused girls suffered from severe adverse outcomes compared to the non-abused girls, including cognitive problems, mental health issues, health issues, and problems with relationships and education. Over time, the abused girls showed signs of numbing in response to distress. They also had trouble forming close friendships, especially before puberty. The researchers concluded that the impact of early abuse was pervasive and long-lasting.

In summary, these two prospective, longitudinal studies prove that early adverse experiences can cause substantial developmental disruptions and have lifelong effects. They contradict the claim that this is "more clinical intuition than research-based fact." The findings from these studies clearly show the deep and enduring impact of child abuse and neglect.

  • Girls going through puberty develop social skills and build friendships that provide support. Sexually abused girls have a much harder time developing these skills and relationships.

  • Sexually abused girls mature sexually earlier, have higher levels of sex hormones, and are more impulsive and less able to protect themselves.

  • The Diagnostic and Statistical Manual of Mental Disorders (DSM) offers many labels for the problems of severely traumatized people but lacks validity. The diagnoses focus on surface symptoms and ignore underlying causes like Trauma.

  • The British Psychological Society and others criticized the DSM for framing psychological problems as located within individuals rather than recognizing social causes. The DSM ignores Trauma, abuse, and deprivation.

  • The National Institute of Mental Health rejected the DSM's symptom-based diagnoses and symptom-based research in favor of a new framework focused on biological measures and brain circuits. However, mental health also depends on relationships and social factors.

  • Understanding development and how different factors interact over time is needed to understand mental health issues fully. More than simply listing ingredients or focusing on biology is required.

  • Frontline mental health workers support an approach focused on the effects of Trauma, attachment, dysregulation, and problems with identity—rather than the DSM's diagnoses.

  • Recognizing developmental trauma disorder would focus research and treatment on the actual issues of traumatized children and adults: dysregulation, attachment problems, focus/attention issues, and identity issues. The challenge is applying what we know about neuroplasticity to help them heal.

• Julian was asked to undergo a psychiatric evaluation to determine if his memories of being sexually abused as a child by Father Paul Shanley were credible, even though he had repressed these memories for over ten years.

• When Julian's girlfriend mentioned an article about Paul Shanley being investigated for child molestation, Julian suddenly began recalling traumatic memories of his abuse by Shanley. He experienced panic attacks, seizures, and agitation.

• Julian met Father Shanley when he was six years old. He remembered Shanley taking him out of CCD class for confession and playing strip poker. He believes Shanley fingered him anally on multiple occasions. His memories were fragmented but included images of Shanley's face and isolated incidents of abuse.

• Julian struggled with low self-esteem, used drugs and steroids, had many sexual partners, and was virtually homeless for a year after high school before enlisting in the Air Force. He received an administrative discharge shortly after recalling the abuse.

• The controversies surrounding recovered traumatic memories and the Shanley case reflect the complex nature of traumatic memory. Traumatic memories are often sensory and emotional rather than coherent narratives. They may be repressed for a long time before being recalled.

• The summary suggests that while Julian's memories were fragmented and incomplete, the context of his life history and symptoms following the memory recovery suggest that the abuse likely occurred, despite the lack of a continuous or comprehensive narrative memory of events. The memories were also supported by sensory details that would be difficult to fabricate. However, without further evidence, a definitive conclusion cannot be drawn.

  • Julian remembered being sexually abused as a child by Father Shanley, a priest. He had repressed these memories for years but recently started remembering fragments of the abuse through disturbing images, physical reactions, and reenactments.

  • The human mind has an extraordinary ability to rewrite and distort memory over time. How accurately we remember an event depends on how emotionally meaningful and arousing it was. While ordinary events are quickly forgotten, traumatic events that evoke adrenaline and strong emotions are typically remembered with vivid detail. However, when a memory is too horrifying, the mind can become overwhelmed and shut down, preventing the memory from being correctly stored and integrated.

  • Julian's traumatic memories consisted of fragmented sensory traces (images, sounds, physical sensations) rather than coherent stories. This is common for people with a history of Trauma. Their disorganized and disconnected memories reflect how the emotional brain took over during the traumatic experience.

  • In the late 19th century, hysteria and "railway spine" were studied as conditions related to traumatic memory loss and dissociation. Pioneers like Charcot, Janet, and Freud saw that Trauma, especially childhood abuse, was the root cause of hysteria. They referred to traumatic memories as "pathogenic secrets" that kept forcing themselves into the sufferer's mind.

  • Politics influenced the study of hysteria in France. Charcot hoped to use mental trauma theories to argue against the catholic church's power church. The church's doctrines implied that mentally ill people were possessed or morally deficient. Charcot argued that traumatic life events could create pathological changes in the brain and cause mental illness.

  • In summary, Julian's experience illustrates how traumatic memories are expressed through fragmented and disconnected traces rather than coherent stories, reflecting how the emotional brain dominates during Trauma and disrupts the integration of memory. The study of hysteria in Charcot's time revealed the role of Trauma in creating this kind of dysfunctional memory.

  • Jean-Martin Charcot and Pierre Janet investigated hysteria at the Salpêtrière asylum in Paris in the late 19th century.

  • Charcot focused on the physiological symptoms of hysteria, while Janet investigated patients' mental experiences. Janet discovered dissociation and trauma-related amnesia in his patients.

  • Janet's patient Irène had amnesia for her mother's death but would reenact caring for her dead body. Janet found that traumatic memories are involuntary, non-adaptive, and lack emotion. He coined the term "dissociation" to describe the splitting of traumatic memories.

  • Janet predicted that people would experience psychological and social decline without integrating traumatic memories. His insights anticipated modern understandings of PTSD.

  • Freud studied with Charcot and was influenced by Janet. Early in his career, Freud believed that hysteria was caused by childhood sexual abuse. He later de-emphasized actual Trauma and focused more on fantasy and the unconscious. However, he continued to recognize the role of dissociation and amnesia in Trauma.

  • The work of Charcot, Janet, and Freud helped establish the "talking cure" and laid the groundwork for modern trauma treatment. Their findings emphasized dissociation, traumatic amnesia, and the need to integrate traumatic experiences verbally.

The legacy of Breuer and Freud's 1893 paper on hysteria and the "talking cure" lives on today, believing that discussing a traumatic experience in detail can help overcome it. However, traumatic reenactments and repetitions show this is not always the case. Reenactments of traumatic events can lead to misdiagnosis and lack of proper treatment.

The debate over the existence of "repressed memories" that Freud proposed continues today. The case of Paul Shanley showed how controversial and complex this issue is. His conviction was upheld despite arguments that no scientific evidence existed for "repressed memories."

Interest in the study of Trauma has fluctuated over time. After an initial peak in the late 19th century with Charcot and others, interest declined until World War 1. During the war, the British military tried to suppress the diagnosis of "shell shock" and its treatment to maintain troop strength. However, the large number of traumatized soldiers could not be ignored. After the war, the British government tried to undermine recognition and treatment of shell shock to avoid paying compensation.

In the U.S., World War 1 veterans were initially treated as heroes but later struggled and felt neglected. In 1932, unemployed veterans camped in Washington, DC, to ask for early payment of bonuses they had been promised. The government sent in troops to forcibly remove them.

History shows how political and economic factors can influence the recognition and treatment of Trauma. Traumatic disorders threaten the status quo, and governments and institutions may try to suppress them for their purposes. However, the scale of suffering in events like world wars means they cannot be ignored completely. There are constant tensions between recognizing and denying traumatic disorders.

  • In 1932, World War I veterans marched on Washington to demand payment of bonuses promised to them. The U.S. Army violently dispersed the protesters. The veterans never received their pensions.

  • The horrors of World War I were depicted in literature and art, including the famous novel All Quiet on the Western Front. The book describes the Trauma and alienation experienced by soldiers. Although it was popular, the Nazis later burned the book.

  • World War II prompted new research on "war neuroses." Treatments focused on hypnosis. However, after the war, interest in Trauma faded, and PTSD was removed from diagnostic manuals.

  • Interest in Trauma revived with the Vietnam War and the feminist movement. In the 1970s, many survivors of Trauma came forward, leading to the inclusion of PTSD in the DSM.

In the 1990s, a "false memory syndrome" backlash claimed that traumatic memories were often fabricated. Despite evidence of Trauma and memory loss going back over a century, many media reports stated there was no evidence that people remember Trauma differently.

  • The delayed recall of Trauma was accepted when first studied but later became controversial, even though extensive evidence supports it. The backlash seemed to reflect a desire to deny the reality of traumatic experiences.

  • Overall, society's willingness to recognize the impact of Trauma has fluctuated based on cultural and political factors. There have been repeated cycles of discovery, denial, and rediscovery.

  • Repressed memory and delayed recall of traumatic events have been documented for over a century. Studies show that 19-38% of people experience memory loss from childhood sexual abuse.

  • A study by Linda Meyer Williams found that 38% of women could not recall documented sexual abuse 17 years later. 12% said they were never abused. 68% reported other incidents of abuse. Those abused at a younger age or by someone they knew were more likely to forget. Recovered memories were as accurate as never-forgotten memories.

  • While studies show traumatic memories can be forgotten and resurfaced, some scientists deny this based on a lack of lab evidence. Lab studies on implanted "false memories" or unreliable eyewitness testimony are not equivalent to real traumatic memory. Real Trauma cannot be ethically induced in labs.

  • A study compared recall of traumatic and benign memories. While people had vivid sensory details of traumatic memories, benign memories were just stories from the past. Traumatic memories were disorganized, with gaps, while benign memories had a clear beginning, middle, and end.

  • Traumatic memories elicited physical reactions, like feeling raped again from a smell. Benign memories did not.

  • The controversy over repressed memory declined as the profitability of testifying in court cases declined. Clinicians were left to handle the effects.

  • Neuroscience shows retrieved memories change. Untouched memories do not change, but telling them modifies them, as the mind makes meaning of experiences.

  • In summary, there is considerable evidence from studies of real people that traumatic, frightening memories work differently from everyday memories of benign events. They are more likely to be forgotten and recovered, disorganized or gappy, viscerally re-experienced, and changed by retelling.

  • Nancy underwent a routine tubal ligation surgery but was given insufficient anesthesia and awoke during the procedure. She was paralyzed and unable to alert the doctors that she was awake.

  • For days after the surgery, Nancy felt disconnected from reality and anxious but did not know why. Four days later, she started having flashbacks of hearing conversations during her surgery and feeling her paralyzed body being burned.

  • Nancy suffered from severe PTSD symptoms, including insomnia, irrational fears, flashbacks, dissociation, rage, suicidal thoughts, and weight loss. She avoided reminders of hospitals like elevators, surgical floors, and cafeterias.

  • Three weeks after her surgery, Nancy returned to her job as a hospital nursing director. An encounter with a doctor in surgical scrubs caused her to have intense flashbacks, terror, and dissociation.

  • Gradually, Nancy was able to piece together her traumatic memories from flashbacks and create a coherent narrative of her experience waking up during surgery and experiencing horrible pain but being unable to alert the doctors or move.

  • While Nancy was eventually able to tell the story of her Trauma, she continued to suffer from debilitating PTSD symptoms that disrupted her life, work, and relationships.

The key finding from Nancy's experience is that while trauma survivors may eventually be able to describe and share the story of what happened to them, this does not necessarily abolish the severe and frightening symptoms of PTSD, like flashbacks, insomnia, dissociation, or panic. Traumatic memories fundamentally differ from everyday memories and continue to haunt the survivor even after the Trauma is articulated into a coherent narrative.

The author argues that trauma recovery should focus on regaining control and ownership over oneself rather than revisiting the traumatic events. Trauma disrupts a person's sense of self-leadership by overwhelming them with difficult emotions and physical sensations. Recovery involves learning to remain calm in the face of trauma reminders, engage fully in the present moment, avoid keeping secrets, and feel free to experience one's emotions and knowledge.

These goals overlap and progress at an individual pace. The author discusses specific methods for accomplishing them in the following chapters. The methods draw on her experience treating patients and her own experiences. Studies have shown many of the methods to be effective.

Revisiting Trauma requires first establishing safety and coping strategies to avoid retraumatization. Trauma reactions stem from the emotional brain, expressed physically rather than the rational brain. Understanding why these reactions occur is useful but insufficient alone. The emotional brain must be targeted explicitly through methods that induce feelings of safety and control. Talk therapy can then be helpful.

Focusing on the trauma story itself is less important than regaining control of oneself in the present. The emotional brain drives posttraumatic symptoms, so recovery methods must address the physical and emotional. Cognitively understanding Trauma is not enough. The emotional brain must first be calmed through strategies that create feelings of safety and control. Then talk therapy and revisiting memories can become helpful.

The key goals and strategies are: (1) finding ways to stay calm; (2) maintaining calm when triggered; (3) living fully in the present; (4) avoiding secrecy; (5) experiencing one's feelings and knowledge freely. Methods for achieving these include regulating the emotional brain through breathing, meditation, exercise, and body-based therapies. Talk therapy then becomes useful for understanding and putting the story into words.

The most critical first step is learning to regulate the emotional brain. The traumatic story itself is secondary. Recovery is a nonlinear process focused on ownership of self in the present rather than the past.

• Emotions arise from the limbic system, while rational thinking arises from the prefrontal cortex. Although the rational brain cannot eliminate emotions, it can help regulate emotional reactions.

• Trauma impacts the balance between the emotional and rational brain. Recovery involves restoring this balance so that emotional reactions do not overwhelm rational thinking and self-control.

• The only way to consciously access and influence the emotional brain is through self-awareness and "limbic system therapy." This involves techniques like mindfulness, breathwork, and body awareness to gain awareness and control over emotions and physical reactions.

• Hyperarousal involves an overreactive emotional brain, which leads to feeling overwhelmed by sensations and emotions. Calming the body through breathing, relaxation, and mindfulness helps gain awareness and control over hyperarousal.

• Mindfulness cultivates self-awareness and the ability to observe emotions and sensations without being overwhelmed. This allows traumatized individuals to tolerate discomfort and stay within their "window of tolerance." Mindfulness helps recognize the transient nature of emotions and gives more options for responding than habitual reactions.

• The first step in changing emotional reactions is opening up to experience inner sensations and emotions. Gaining awareness of these sensations through mindfulness and labeling them helps to recognize their impermanence. This allows one to stay within the "window of tolerance" even when experiencing discomfort. Exploring how sensations change in response to small shifts can help build tolerance.

• Overall, the fundamental principles are gaining awareness and control over the emotional brain through self-regulation techniques focused on the body and breath. Observing and tolerating discomfort leads to more flexibility and control over reactions and choices in how to respond.

  • Take deeper breaths and notice your body sensations to help calm yourself. Paying attention to your physical sensations can help you process emotions and memories.

  • Mindfulness practices like meditation can help improve emotional regulation, decrease stress and anxiety, and promote awareness of the connection between your thoughts and physical sensations. Mindfulness has been shown to lead to positive changes in the brain.

  • Relationships and social support are critical for recovering from Trauma. Feeling safe with others helps to counteract the fear of past traumas. Connecting with others also helps to calm fears and regulate emotions.

  • Finding a skilled therapist is essential for addressing Trauma. Look for therapists trained in trauma treatment whom you feel comfortable with. The therapist should be open-minded, curious about you as an individual, and able to make you feel safe. Feeling safe is necessary to confront traumatic memories and fears.

  • There are many effective treatments for Trauma, so a therapist should not claim that only their approach works. Therapists should have experience with the treatments they provide and be open to you exploring other options as well.

  • The qualities of a good therapist include the following:

  • Training and experience treating trauma

  • Making you feel safe, heard, and understood

  • Being open-minded and curious about yourself as an individual

  • Using a collaborative approach tailored to your needs

  • Having a comfortable and confident demeanor

  • Willingness to learn from you and adjust treatment accordingly

The key signs of an ineffective therapist include being:

  • Judgmental, harsh, or stern

  • Overly rigid in using a particular treatment approach

  • More focused on symptoms than on understanding you as a person

  • Unable to make you feel safe discussing traumatic memories and fears

  • Many trauma survivors remember a teacher, neighbor, or another caring figure from childhood who showed them kindness. These memories give hope that relationships can be healing.

  • Working with animals can be a safer way to reconnect for those without such memories. Equine therapy and programs pairing veterans with service dogs have been effective.

  • Community rhythms and synchrony, like singing, dancing, and improv, help trauma survivors reconnect with others and feel less frozen. Examples include a group of South African rape survivors who came alive while singing and dancing together.

  • Sensory integration techniques, like providing swings, ball pits, and blankets, helped a mute five-year-old girl from China begin talking after six weeks. The Trauma Center has started using similar techniques.

  • Getting in touch through bodywork, massage therapy, and other touch techniques helps calm trauma survivors and make them feel safe in their bodies. A practitioner describes starting with a personal connection, assessing tension, and using slow, confident touch to release frozen areas. This helps people feel boundaries and safety in their bodies.

  • Taking action through exercise, sports, yoga, and physical games helps burn off energy and restore a sense of agency and empowerment. While Trauma often makes people feel helpless, action and empowerment are antidotes. Exercise also releases endorphins to improve mood and sleep.

In summary, techniques for re-engaging the body and promoting community connection can benefit trauma recovery. While talk therapy has its place, healing Trauma is incomplete without addressing the physical and social dimensions

• Stress hormones activate our fight or flight response in dangerous situations. However, when people experience traumatic events and feel helpless, their stress hormones continue to pump even though there is no action to fuel. This can lead to health issues.

• Therapies like sensorimotor psychotherapy and somatic experiencing help people deal with trauma by focusing on the physical sensations in the body rather than the story of what happened. These therapies help expand people's "window of tolerance" to access traumatic memories without being overwhelmed.

• Once people can tolerate traumatic memories, these therapies help them complete the fight or flight actions that were thwarted during the trauma. This helps resolve the trauma.

• Cognitive behavioral therapy repeatedly exposes people to traumatic memories in a controlled setting. This helps them form new associations between the memories and the fact that they are safe. This makes the memories less disturbing and helps reduce avoidance.

• Hypnosis may also help by inducing a relaxed state where people can observe their traumatic memories without being overwhelmed. This can aid in integrating the memories.

• A coherent narrative of the traumatic event is essential for healing, but simply talking about the event does not necessarily resolve the underlying traumatic responses. Effective therapies keep the brain areas necessary for staying present and maintaining a sense of time engaged while people access traumatic memories. This allows proper integration and resolution of the trauma.

• Prolonged exposure or "flooding" treatments, where patients relive their trauma in an intense, sustained manner, have been studied extensively but often do not resolve PTSD and can worsen symptoms. Patients frequently drop out or suffer adverse reactions.

• Cognitive behavioral therapy has limited effectiveness for PTSD, especially for patients with histories of childhood abuse. Only about one-third of participants show improvement, and most still have significant PTSD symptoms after treatment.

• Desensitization, or helping patients become less reactive to emotions and sensations, is the prevailing treatment taught to psychologists. However, PTSD may be better addressed by integrating the traumatic event into a proper perspective. Desensitization can lead to blunting of emotional sensitivity.

• Psychedelic substances like MDMA show promise for helping patients access and integrate traumatic memories without being overwhelmed. Small studies of MDMA-assisted psychotherapy found that over 80% of participants experienced the loss of PTSD diagnosis. However, psychedelics must be used carefully due to their history of misuse.

• Mainstream psychiatry relies heavily on medications to treat PTSD, spending billions of dollars on antidepressants, antipsychotics, and antianxiety drugs. However, drugs can only dampen symptoms, not cure the underlying trauma. They help control feelings and behavior but often at the cost of emotional blunting and other side effects.

• In summary, the most promising treatments for PTSD appear to help patients access and integrate their traumatic experiences, rather than simply dampening emotional and physiological arousal. However, these approaches must be administered carefully and ethically. Medications and desensitization can play a role, but should not be the primary treatment. Overall, there is no simple or single solution, and a holistic, patient-centered approach is needed.

  • The author discusses various medications for PTSD, including SSRIs, medications targeting the autonomic nervous system, benzodiazepines, anticonvulsants, and antipsychotics.

  • SSRIs can help make feelings less intense and life more manageable but can also make some patients feel blunted. The author takes an empirical approach to find what works for each patient. SSRIs have been found more effective for PTSD than Prozac.

  • Medications targeting the autonomic nervous system can decrease hyperarousal and reactivity to stress by blocking the effects of adrenaline. The author now uses these less frequently, preferring mindfulness and yoga.

  • Benzodiazepines can calm patients but have a high addiction potential and may interfere with trauma processing. The author gives patients low doses to use as needed.

  • Anticonvulsants and mood stabilizers can take the edge off hyperarousal and panic but have only mildly positive effects.

  • Antipsychotics are controversial but in low doses can calm combat veterans and adults with PTSD from childhood abuse. However, they can dampen the emotional brain, cause weight gain and diabetes risk, and make patients physically inert. They are overprescribed to children, often without proper assessment.

  • Dissociation, self-mutilation, fragmented memories, and amnesia do not respond to medications.

  • Studies show traumatized civilians respond better to medications than combat veterans. However, the Department of Defense and V.A. often prescribe high volumes of medications without providing therapy. They have spent hundreds of millions on drugs like Seroquel, Risperdal, and benzodiazepines despite limited effectiveness and risks.

  • The author describes the evolving treatment of a patient named Bill over 30 years to illustrate changing approaches to trauma. Bill was initially treated with medications and talk therapy. Later EMDR helped integrate his traumatic memories. Addressing his childhood trauma and working as a minister providing grief support was also helpful. His third round of treatment addressed the trauma of a severe illness. Bill became an advocate, starting a clergy support group.

• Talk therapy is widely believed to help resolve trauma, but traumatic events are almost impossible to put into words. Images, not stories, are our initial imprints of traumatic events. It takes time and effort to construct a narrative.

• Silence about trauma reinforces isolation and prevents healing. Breaking the silence by naming the trauma allows healing to begin. Being able to say aloud what happened is a first step toward overcoming trauma.

• Feeling listened to and understood changes our physiology and creates an "aha moment." In contrast, being met with silence and incomprehension worsens the effects of trauma.

• Hiding trauma from yourself keeps you stuck in fear and stress. You may overreact to triggers without understanding why. Suppressing information takes enormous energy and prevents you from living fully.

• Ignoring trauma eats away at your sense of Self and identity. It leads to feeling dead inside, having no future, and feeling like an object rather than a person.

• Identifying the source of trauma-related responses allows you to start using your feelings as signals to address underlying issues. Naming the trauma is the first step toward gaining control and overcoming its effects.

Here is a summary of the key points:

•Knowing yourself requires tremendous courage, as facing painful truths about yourself can be agonizing.

•Vietnam veteran Karl Marlantes struggled to integrate the part of himself that loved violence with his more compassionate side. He found healing by telling the truth about his experiences, even though it was difficult.

•Discovering yourself through language is often an epiphany. Helen Keller's story illustrates how acquiring language enabled her to find her sense of Self after being deaf and blind as a child.

•We have two ways of knowing ourselves: through the stories we tell about our lives and our moment-to-moment felt experience. Different parts of the brain mediate these two forms of self-awareness.

•Telling stories about our lives allows us to make meaning of our experiences, but these stories are malleable and change over time. Our felt experience in the present moment taps into a more profound truth.

•A young woman with epilepsy told a coherent story about her life but showed little emotion. Questions tapping into her felt experience revealed the pain of her childhood diagnosis and her harsh self-judgment. Accessing this deeper layer of experience allowed for greater understanding and compassion.

•Language allows us to share our inner worlds with others, but we often have to choose between focusing on our felt experience or logically telling our stories. True healing comes from integrating these dual modes of awareness.

The key theme is that while the stories we construct about our lives serve an essential purpose, honestly knowing ourselves requires connecting with our felt experience in the present moment. Finding the language to share this deeper layer of Self with others enables profound healing. Integrating our logical mind and emotional experience is fundamental to psychological and spiritual well-being.

  • Trauma stories provide context for people's suffering and help them feel less alone. However, stories can also obscure the fact that trauma fundamentally changes people.

  • It is hard to articulate the feeling of no longer being yourself. Language evolved to describe the external world, not our inner experiences. Engaging the body-based Self through sensations, tone of voice, and tensions can help access these experiences.

  • Writing to yourself is another way to access your inner world. Free writing without judgment can reveal surprising truths. Patients often share fragments of private writing with their therapists to provide guidance.

  • James Pennebaker tested the power of language to relieve trauma. He had students write about traumatic experiences for 15 minutes daily for four days. Those who wrote about both facts and emotions had 50% fewer doctor visits and improved health and mood.

  • A follow-up study involved students discussing trauma or daily plans in a tape recorder. Those discussing trauma showed immediate and longer-term physiological changes, like lowered blood pressure.

  • Many studies show that writing about trauma improves physical and mental health for diverse groups. Pennebaker found that discussing trauma often changed people's tone of voice and posture, suggesting a mind-body connection.

The key points are:

  1. Language is limited in articulating inner experiences and the changed Self resulting from trauma.

  2. Engaging the body and expressive acts like free writing help access these deeper parts of the Self.

  3. Studies show that expressing trauma through writing or speech has significant psychological and physical health benefits, both short and long-term.

  4. Changes in tone of voice and posture accompanying the expression of trauma suggest a mind-body connection. Trauma and healing are physiological as well as psychological.

Does this summary accurately reflect the response's key ideas and supporting evidence? Let me know if you wantwant me to clarify or expand on any summary part.

  • Trauma can overwhelm a person's ability to speak about it. This is called "switching" - a person adopts dramatically different speaking styles, facial expressions, and behaviors when discussing different topics, especially traumatic ones.

  • Forcibly silencing a patient who exhibits switching can worsen their condition and lead to acting out or self-harm. Expressive therapies like art, music, and dance can help circumvent speechlessness from trauma. A study found that while expressing trauma through movement and writing led to improved health, movement alone did not. Language may be necessary to process trauma fully.

  • However, language also has its limits in discussing trauma. Traumatic events can overwhelm listeners and make others reject the person speaking about them. Trauma support groups and therapists are necessary to find understanding listeners. When someone becomes speechless from trauma, pendulating between exploring the trauma and finding "islands of safety" in the body can help.

  • Dealing with traumatic memories is just the start. People with PTSD also often struggle with attention, learning new information, and dealing with ambiguity. Treatment must also address learning to tolerate distress, regulate emotions, and connect with others who can offer comfort. The capacity to think flexibly and express one's needs are crucial to recovery.

  • In summary, processing trauma requires expressing the inexpressible through movement, art, writing, and speech. However, expression alone is not enough - one must also reconnect with others, re-establish a sense of safety, regain flexible thinking, and learn emotional regulation skills to deal with the reality of what has happened.

  • Normal people can name 15 words starting with B in a minute, while PTSD patients can only name 3-4 words. PTSD patients also hesitate and react negatively to ordinary words.

  • Most PTSD patients expend much energy to get through the day despite being successful in other areas of life.

  • Challenging negative thoughts of PTSD patients often do not work, as their thoughts are like flashbacks. It is better to treat them with EMDR.

  • Trauma changes the brain, especially the insula, which interprets internal sensations and triggers fight or flight responses. This results in alexithymia or loss of ability to identify and communicate internal sensations. Recovery requires reconnecting with one's body and Self.

  • Language is essential to construct a coherent sense of Self but trauma disrupts the connections between the conscious mind and bodily Self. The whole story of trauma can only be told after these connections are repaired.

  • EMDR helped a patient overcome a traumatic memory from 30 years ago that was causing rage and nightmares. By recalling the traumatic memory while moving his eyes back and forth, the memory lost its intensity over a few sessions. Additional sessions helped him overcome associated problems like alcoholism and improve his relationships.

  • EMDR helps make painful recreations of trauma a thing of the past by recalling traumatic memories while moving the eyes.

  • Maggie was a patient referred to Bessel van der Kolk's therapy group. She had a traumatic childhood, with her father raping her at a young age. She blamed herself for the incidents.

  • Maggie attended an EMDR training and had a breakthrough, realizing that her father's actions were not her fault. She was able to see herself as the child she was at the time of the trauma. Her anger and blame for others decreased after this experience.

  • Van der Kolk was initially skeptical of EMDR but became interested in it after Maggie's experience. He went through EMDR training himself and found it helpful in processing his distress over his clinic being shut down.

  • During the training, van der Kolk conducted EMDR on a classmate who would not disclose any details about his trauma. Although the classmate was rude to van der Kolk and did not like him, he reported that the EMDR session resolved his issues. This showed van der Kolk that EMDR could be helpful even without a trusting relationship or disclosure of trauma details.

  • Van der Kolk found three exciting aspects of EMDR: it provides access to loosely associated memories, can help without verbal discussion of the trauma, and can be effective even without a trusting relationship.

  • Van der Kolk and colleagues studied EMDR, finding significant decreases in PTSD symptoms and changes in brain scans after just a few sessions.

The key points are that EMDR can be remarkably effective for processing trauma, even without detailed disclosure or a trusting relationship, because it taps into the mind's associative processes. Van der Kolk became convinced of the power of EMDR after seeing its effects in case studies, self-experimentation, and systematic research.

  • Researchers studied the effects of EMDR therapy on trauma patients.

  • EMDR therapy helped shift activity in the prefrontal cortex, anterior cingulate, and basal ganglia.

  • This neurological shift helped patients experience their trauma memories differently—with more distance and control. Patients reported feeling less overwhelmed by the memories.

  • A study compared EMDR, Prozac, and a placebo in 88 patients with PTSD.

  • After eight weeks of treatment, 25% of EMDR patients were cured (negligible PTSD symptoms), compared to only 10% of Prozac patients.

  • 8 months later, 60% of EMDR patients were cured, compared to none of the Prozac patients (who relapsed after stopping the drug).

  • EMDR was very effective for adult-onset trauma but less so for trauma from chronic childhood abuse. Childhood trauma may require more prolonged treatment.

  • EMDR helps integrate traumatic memories instead of just desensitizing people to them. After EMDR, memories feel like coherent events in the past instead of overwhelming experiences in the present.

  • EMDR sessions involve recalling a traumatic memory while moving the eyes back and forth. This helps integrate the memory and makes it feel less distressing.

  • An example showed how EMDR helped a patient integrate her traumatic memories throughout eight sessions. After 15 years, she recovered and led a happy, fulfilling life.

EMDR appears to be a promising therapy for PTSD, especially for adult-onset trauma. It helps rewire the brain to integrate traumatic memories healthily. For some patients, it can lead to full recovery and a return to well-being.

  • Kathy reported disturbing memories and images of childhood abuse during an EMDR session with the therapist. She recalled being gang raped, tied up, and doused in gasoline by her father and his friends as a little girl.

  • After a few sequences of eye movements, Kathy began to report more positive memories and images, such as taking a karate class and standing up to her abusers. She felt a sense of relief and empowerment.

  • However, the traumatic memories, along with intrusive smells and sensations, continued to return. Kathy recalled her mother and grandmother apologizing for not protecting her.

  • By the end of the session, Kathy reported feeling like "it is over." She imagined pushing her father out of a coffeehouse and her boyfriend locking the door behind him.

  • The therapist notes that EMDR seems to activate a flow of sensations, emotions, images, and thoughts associated with a traumatic memory. This process may help integrate traumatic memories, similar to how we integrate everyday experiences.

  • EMDR's alternating stimulation is analogous to the rapid eye movements of REM sleep. REM sleep is essential for processing emotional memories, regulating mood, and forging new connections between memories. People with PTSD often have disrupted REM sleep.

  • EMDR may work by altering the brain similarly to REM sleep, helping to integrate traumatic memories and form new associations. This can give rise to new insights and perspectives on past traumatic experiences.

• The author describes a patient named Annie who suffered severe childhood abuse and trauma. Annie had difficulty speaking about her experiences and often shut down or froze when remembering traumatic events.

• The author used breathing techniques, tapping, and other methods to help Annie stay within her "window of tolerance" and calm her physiological arousal. These techniques helped Annie gradually open up about her experiences.

• Annie's trauma had caused her amygdala to become hyperreactive, interpreting certain situations as threatening even when they were not. This caused Annie to experience fight, flight, or freeze reactions even in safe situations. Annie also associated excitement with danger because her father would molest her after coming home, causing those positive feelings.

• Trauma survivors often numb themselves to avoid unpleasant internal experiences. This can lead to addictions, risky behaviors, chronic pain, obesity, anorexia, and other issues. Muscle tension and pain are common results of chronic fear and anger.

• The author argues that truly overcoming trauma requires returning to the traumatic experiences, feeling the sensations and emotions, and gaining a fuller understanding of what happened. This allows the limbic system and survival responses to be rewired with the knowledge that the threat has passed.

• The overall message is that trauma causes physiological changes and damage that require physiological interventions and a mindful reexperiencing of the trauma to heal. Talk therapy and medication alone are often not enough. Body-based techniques are essential for recovery.

  • The diagnosis and treatment of trauma survivors like Annie often fail to address the underlying physiological issues caused by trauma.

  • Therapy for Annie focused on helping her stay calm and notice her physical sensations without judgment so she could see them as remnants of the past, not current threats.

  • To better understand arousal regulation, the author's team studied heart rate variability (HRV), a measure of the autonomic nervous system. They found that PTSD patients have low HRV, indicating an imbalance in their nervous systems.

  • In search of ways to improve HRV, the team came across yoga. Though little studied, yoga is claimed to help HRV and other issues. They brought in a yoga teacher who developed a yoga program for PTSD.

  • Their research found yoga significantly improved PTSD symptoms and HRV, unlike an established therapy. They expanded the program to veterans and found similar success.

  • Yoga combines breathwork, poses, and meditation. Different schools emphasize different intensities and balances, but trauma-sensitive yoga is gentle, focusing on mindfulness of the body.

  • For PTSD, the essential elements are mindfulness of the breath and body, relaxation, and cultivating a compassionate attitude toward one's physical and emotional discomfort. This helps correct low HRV and the tendency to dissociate from one's body.

  • With practice, yoga can transform trauma survivors' relationships with their bodies from sites of fear and pain to sources of strength, flexibility, and joy. However, it requires patience and self-compassion.

In summary, the research team found yoga helpful for addressing the underlying physiological dysregulation and bodily alienation caused by trauma. By improving HRV and helping patients cultivate mindfulness of and compassion for their bodies, yoga promises to transform trauma survivors' relationships with their physical selves.

The key components of yoga that help with trauma recovery include:

  1. Focusing attention on breathing. This helps develop awareness and regulation of arousal and emotions. Different breathing techniques can have calming or energizing effects.

  2. Paying attention to sensations and the connection between emotions and the body. This cultivates interoception or awareness of internal states. It helps people notice how their body reacts to emotions and make choices to influence their state.

  3. Movements that release tension and create a rhythm of tension and relaxation. The sequences of poses are designed to help people learn to tolerate sensations and find a balance of arousal and calm.

  4. Cultivating mindfulness through observing the body during movement. This fosters a caring, nonjudgemental attitude toward the body and inner experiences. It helps overcome tendencies toward avoidance and dissociation.

  5. Learning that discomfort is temporary. Moving in and out of challenging poses helps strengthen the capacity to tolerate distressing sensations and emotions. It teaches that all experiences pass, which changes how people view themselves and their emotional states.

  6. Releasing tightness around trauma-related areas. Hip openers, chest openers, and grounding feet and leg poses can trigger emotional release and insight into how trauma is held in the body. This must be approached carefully at a slow pace.

The effects of yoga for trauma recovery include decreased symptoms of PTSD and depression, improved sleep and concentration, decreased dissociation and numbing, increased awareness and tolerance of inner experiences, and an improved relationship with the body. However, the intensity of sensations and emotions that can arise during yoga must be approached with patience and care. Dropping out rates of studies are higher for yoga, indicating it may be too much for some. A slow, mindful pace is essential.

Does this summary accurately reflect the key ideas and effects of yoga for trauma recovery from the passage? Let me know if you wantwant me to clarify or expand on any part of this summary.

  • After twenty weeks of yoga practice, chronically traumatized women showed increased activation in two critical brain regions involved in self-regulation: the insula and the medial prefrontal cortex.

  • The insula and medial prefrontal cortex are involved in interoception, sensing the body's physiological state and self-awareness.

  • The yoga practice, which cultivates awareness and acceptance of bodily sensations, may have contributed to changes in these brain regions.

  • The participants reported increased awareness of bodily sensations and emotions and an ability to regulate extreme emotions. One participant said she learned to "notice without being so afraid."

  • The changes allowed participants to feel safer in their bodies, communicate traumatic experiences through language rather than being overwhelmed by them, and experience intimacy.

  • These findings suggest yoga and other mindfulness practices that increase awareness and acceptance of bodily sensations may help to heal trauma by enhancing self-regulation.

Here is a summary of the key ideas:

  1. The mind can be understood as a mosaic of parts or subpersonalities. These parts have their perspectives, beliefs, emotions, and agendas. In healthy people, these parts work together harmoniously. In traumatized people, these parts become polarized and go to war.

  2. Traumatic experiences lead to the development of "exiled" parts that hold traumatic memories and emotions. These exiles are denied or avoided. "Protector" parts then emerge to shield the exiles and the rest of the Self from their painful contents. These protectors take on the qualities of the abuser and become polarized.

  3. The parts of traumatized people often operate autonomously, holding different aspects of memories, beliefs, and emotions. The person may not even be aware of some parts. The most visible parts are often disliked, even though they serve a protective function.

  4. The key to healing from trauma is developing self-leadership to harmonize these parts. This involves recognizing that each part has a role in protecting the Self, even if its methods are now counterproductive. Compassion and mindfulness help in surveying the inner landscape and providing leadership to meet the needs of all parts.

  5. The internal systems of traumatized people lack effective leadership and operate under extreme rules. Healing involves collaborative therapeutic work to help develop self-leadership, set flexible rules, and meet the needs of all parts. The parts can then trust the self-leadership and relax their protective roles.

The summary covers the essence of the ideas regarding understanding the mind as comprised of parts, especially in traumatized people and cultivating self-leadership through a compassionate and collaborative therapeutic process. Please let me know if you want me to clarify or expand on any summary part.

  • In IFS therapy, the "Self" refers to a calm, confident, and curious essence underlying the protective parts formed in childhood due to trauma or emotional neglect. The Self can help reorganize these protective parts and facilitate their healing.

  • The parts often operate based on outdated assumptions from childhood and have trouble balancing each other. They frequently "blend" with the Self, causing a loss of self-control and self-observation. The goal of IFS is to unblend the parts of the Self so the Self can assume leadership over the system.

  • The therapist helps the patient identify and know their parts by asking questions like "What inside feels that way?" Parts often appear as images that reflect their roles, like an abandoned child or victim. The therapist then helps the patient build compassion for parts by asking, "How do you feel toward that part?" Addressing extreme responses like hate helps unblend other protective parts.

  • The patient Joan, struggled with uncontrollable emotions, affairs, and bulimia due to childhood sexual abuse and a critical, emotionally neglectful mother. Therapy focused on meeting her managers, like her inner critic, and other parts, like her tantrum-throwing inner child. The goal was for Joan's Self to reassume leadership so she could heal.

  • Managers control access to emotions and try to prevent humiliation, abandonment, and overwhelm. They may be aggressive, perfectionistic, or encourage passivity. They require much energy to maintain control, and a single trigger can activate many parts at once. The Self must reassume leadership from the managers.

  • The summary highlights how IFS views the psyche as composed of an essential Self and various protective parts that emerge from childhood experiences. Unblending the parts of the Self through inner communication and building Self-leadership is crucial to healing. The therapist facilitates this process by helping the patient identify, understand, and have compassion for their parts.

Here are the main points from the summary:

  1. Internal parts like managers, firefighters, and exiles maintain the internal system and protect the individual from emotional pain. However, their extreme protective measures can be harmful.

  2. Managers attempt to control emotions and deny painful experiences. Firefighters act impulsively to avoid emotional pain, even if it means self-destructive behavior. Exiles hold memories of trauma and are avoided because they are too painful.

  3. Joan's managers, firefighters, and exiles emerged during therapy. Her managers were critical and controlling. Her firefighters engaged in binging, purging, and impulsive behavior to avoid pain. Her exiles held memories of childhood abuse and betrayal.

  4. Accessing and liberating Joan's exiles was vital to resolving her trauma. This involved imaginatively re-working scenes from her past and taking action to protect her childhood self. This replaced her sense of helplessness and allowed her to build a stronger Self.

  5. IFS also helped improve Joan's relationship with Brian. Brian's parts emerged, including panicked, protective, and caretaking parts. Accessing Brian's exiled child helped him become less avoidant and build intimacy with Joan.

  6. IFS and accessing internal parts helped Joan and Brian understand themselves and each other with more compassion. This allowed them to move past their painful histories into new possibilities. Resolving trauma and building a solid Self was vital to improving their well-being and relationship.

The summary covers the emergence and roles of different internal parts for Joan and Brian, the importance of liberating exiles and building a solid Self, how parts interact in relationships, and the benefits of IFS for resolving trauma and improving relationships. Please let me know if you want me to clarify or expand the summary further.

  • Nancy Shadick, a rheumatologist, conducted a study to determine if IFS could help rheumatoid arthritis patients.

  • Rheumatoid arthritis causes chronic pain, disability, depression, and anxiety. Medication only helps so much.

  • Shadick created a 9-month study with an IFS and control groups. The IFS group learned IFS techniques to understand their fear, anger, and hopelessness. The control group only received info on managing symptoms.

  • Initially, the R.A. patients had trouble acknowledging their pain due to the stoic parts that helped them cope. The IFS leaders helped the patients identify these parts.

  • After nine months, the IFS group improved pain, function, self-compassion, and depression. These gains remained a year later, though objective measures did not show improvement. The critical factor was the improved ability to live with the disease.

  • Peter, an oncologist, sought therapy at his wife's urging. He was arrogant and saw psychiatry as witchcraft. His childhood involved a Holocaust-surviving father who was brutal but also kind and a mother who showed little care. Peter was determined to avoid feeling like a victim.

  • Peter's wife said he constantly criticized her and was rarely home. She threatened to leave him unless he changed. Peter wanted to work to save the marriage.

  • During therapy, Peter connected with a critical part that protected him from hurt by criticizing others. He realized this part made him lonely and despised. Seeing it as a 7-year-old boy who felt stupid for provoking his father's anger, he felt compassion for this part.

The author attended a conference on body psychotherapy and met Albert Pesso, who practiced a method called PBSP psychomotor therapy. Pesso invited the author to attend one of his workshops, where he witnessed Pesso working with a patient named Nancy. Pesso carefully observed Nancy's body language and verbal responses, validating her experiences through "witness statements." This helped Nancy feel comfortable opening up about painful memories.

Pesso then asked Nancy to choose a "contact person" from the group to sit with her for support. The author noted that this type of spatial positioning and nonverbal communication primarily involves the brain's right hemisphere, where trauma is also primarily processed.

A crucial part of Pesso's method was creating "structures" or reenactments of patients' past experiences using group members as family members and ideal support figures. The author observed that these structures provided patients with a corrective emotional experience, giving them a sense of the support and nurturing they lacked earlier in life.

Intrigued by Pesso's work, the author visited Pesso at his home. Though the author had been in long-term psychoanalysis, Pesso offered to do a structure with him. The author noted that while he thought of his parents as older adults he now cared for, he was unaware of how their behavior when he was young had shaped his implicit Self.

In summary, the author was introduced to Pesso's PBSP method, which uses close observation of patients' body language and verbal responses, the physical positioning of "contact persons" for support, and reenactments of past experiences to provide new emotional experiences that can reshape patients' implicit sense of Self. Though initially skeptical, the author found Pesso's work intriguing and experienced a powerful structure demonstrating how past experiences with his parents had shaped his implicit Self in ways he had not been fully aware of.

The protagonist, Maria, had trouble accessing her emotions during the initial part of the session. With encouragement and mirroring from the therapist, she eventually opened up about her fear and discomfort, especially concerning her father, who terrified her as a child. To help her work through this, the therapist had another group member represent her father. As Maria looked at this representation of her father, she cycled through feelings of terror, compassion, and understanding for the difficulties he faced. She could speak about the abuse her father inflicted on her mother. The therapist continued to mirror Maria's expressions and emotions, helping her feel seen and validated. Overall, the summary depicts Maria's journey to open up about her traumatic past with the help of the group structure method.

• Maria described her mother as loving and warm but unable to protect her and her siblings from their abusive father.

• Maria selected a group member, Kristin, to play the role of her birth mother. When Maria looked at Kristin, she said she felt "nothing," but then expressed anger at her mother's inability to stand up to her father and protect her children. Maria said she wanted her mother to tell her father, "Fuck off," and leave with the children.

• Maria then selected another group member, Ellen, to represent her ideal mother. When Ellen said she would stand up to Maria's father and protect the children, Maria felt delighted. She imagined feeling like a "safe, happy little girl."

• Maria then selected a group member, Danny, to represent her ideal father. She felt joyful when Danny said he would have loved and cared for Maria. Maria imagined a tender moment with an ideal father figure.

• The experience allowed Maria to rescript her painful memories of her youth and explore what it might have felt like to have protective and nurturing parents. Though the events recreated in the structure may not have matched precisely what happened in Maria's childhood, they represented her inner experience and the "rules" she had been living by.

• The structure allowed Maria to disclose painful secrets to imaginary representations of the people who had hurt her, allowing her to work through memories that had previously been too frightening to explore. By recreating these scenes with her ideal parents, she could release herself from interpretations of the present based only on her traumatic past.

That is a high-level summary of the description of Maria's psychomotor therapy structure experience. Please let me know if you want me to clarify or expand on any part of this summary.

  • In the 1920s, Hans Berger invented a way to record the brain's electrical activity, known as the electroencephalogram or EEG. At first, the medical establishment was skeptical, but the EEG became crucial for diagnosing epilepsy.

  • Berger hoped the EEG could also help understand psychiatric problems. Studies in the 1930s found that children with behavior problems and ADHD had slower brain waves in their frontal lobes, impairing their executive functioning.

  • For decades, interest in the brain's electrophysiology declined as pharmacology dominated. However, the EEG and a related technique called neurofeedback have recently shown promise for psychiatric treatment.

  • Neurofeedback, or EEG biofeedback, uses real-time displays of a person's brain waves to teach self-regulation of brain activity. ModifyingModifying brain waves can help improve conditions like ADHD, PTSD, depression, and addiction.

  • Neurofeedback works by amplifying selected frequency bands of electrical activity, such as beta waves for focus or alpha waves for calm. By rewarding the brain for producing the target frequency, neurofeedback can strengthen those neural circuits and retrain the brain.

  • Studies show neurofeedback can normalize brain waves, improve cognitive performance, decrease PTSD symptoms, lift mood, and reduce cravings in addiction. The benefits tend to persist even after treatment ends.

  • Neurofeedback is non-invasive, has minimal side effects, and can be used alone or to supplement other treatments. It promises to rewire the brain in a targeted, long-lasting way directly.

Here is a summary:

  • In 2000, a study showed apparent differences in information processing between traumatized and normal subjects. Traumatized subjects had loosely coordinated brain waves and trouble filtering irrelevant information and focusing. This explained their difficulty learning from experience and engaging in daily life.

  • In 2007, the author met Sebern Fisher, who used neurofeedback to treat children with severe behavioral problems. She showed the author a 10-year-old's drawings that showed a leap in mental development after just ten weeks and 20 sessions of neurofeedback.

  • Neurofeedback gives the brain feedback about its functioning, nudging it to strengthen some brain wave patterns and weaken others. This enhances the brain's natural complexity and self-regulation.

  • In a demonstration, the author used neurofeedback to control spaceships on a screen by producing certain brain wave patterns. Neurofeedback can target specific brain circuits and the author felt different mental states when different areas were targeted.

  • Neurofeedback helps change the brain patterns created by trauma that lead to fear, shame, and rage. Stabilizing the brain increases choices in how people respond to events.

  • Neurofeedback has been used since the 1950s. Early research showed people could learn to control their brain waves, and later work showed it could help with conditions like epilepsy. Neurofeedback works by operant conditioning, rewarding desired brain wave patterns.

  • Many studies have shown that neurofeedback can help with conditions from ADHD to addiction, PTSD, depression, and TBI. It leads to lasting brain changes, though the effects are not always long-lasting. More research is still needed.

• Mary Sterman discovered that giving neurofeedback training to cats made them resistant to seizures caused by the hallucinogenic drug MMH. Building on this, in 1971, she gave neurofeedback training to a 23-year-old woman named Mary Fairbanks, who had frequent grand mal seizures. After three months of training, Fairbanks was virtually seizure-free. Sterman then conducted a more extensive study, published in 1978, showing the effectiveness of neurofeedback for epilepsy.

• In the 1970s, the rise of psychiatric drugs led the field of psychiatry to adopt a chemical model of the mind and brain. Other treatments like neurofeedback were sidelined. Neurofeedback grew slowly, with more research done in Europe, Russia, and Australia. There are 10,000 neurofeedback practitioners in the U.S., but lack of funding and competing systems have limited its acceptance.

• Sebern Fisher, a neurofeedback practitioner, treated a woman named Lisa who had a traumatic childhood, suffering severe abuse by her psychotic mother. Lisa had spent years in mental hospitals and shelters and regularly overdosed or self-harmed. Talk therapy did not work, as discussing trauma caused breakdowns.

• Lisa started neurofeedback at age 18. At first, she was very dissociated, walking around with a vacant stare and carrying a pumpkin. Over 6-12 months of neurofeedback, Lisa became much more straightforward, stopped dissociating, and the "hum of low-level conversations" in her head stopped. She could then do talk therapy and open up about her experiences. Her anxiety and fear also decreased.

• Lisa's story showed the potential of neurofeedback for severe trauma and dissociation. The Trauma Center team decided to explore neurofeedback, spending a weekend learning different systems.

The key findings are:

  1. Neurofeedback can prevent and treat seizures.

  2. Neurofeedback was sidelined for decades but continued to develop slowly.

  3. Neurofeedback helped a severely traumatized and dissociated woman become integrated, decrease anxiety/fear, and benefit from talk therapy.

  4. The Trauma Center team sought to explore neurofeedback based on this potential.

  • The author describes using neurofeedback to treat a colleague named Michael, who suffered from chronic anxiety and a sense of danger. Michael's anxiety and discomfort around others disappeared over the next three years by targeting a specific frequency range over the sensorimotor strip of his brain.

  • The author then describes a study of 17 patients with PTSD who did not respond to previous treatments. By targeting the right temporal area of the brain, the patients showed significant improvements in PTSD symptoms, emotional balance, and self-awareness after 20 neurofeedback sessions.

  • The author gives an example of a patient with compulsive homosexual behavior and a history of childhood sexual abuse. After neurofeedback targeting his right temporal lobe, the patient's compulsive behavior disappeared and he found solace in fishing instead.

  • The author describes the different brainwave frequencies, ranging from slow delta waves (2-5 Hz) to fast beta waves (13-20 Hz). Neurofeedback can be used to normalize abnormal brainwave patterns.

  • The author discusses how neurofeedback has been shown to enhance performance and focus in sports, music, and ADHD. Studies show neurofeedback for ADHD can be as effective as medication.

  • Quantitative EEG (qEEG) provides brainwave maps to identify the abnormal frequency and connectivity patterns. The qEEG shows how mental states transcend the boundaries of diagnoses in the DSM. The more problems a patient has, the more abnormalities appear on their qEEG.

  • In summary, the author presents neurofeedback as a promising treatment for conditions like PTSD, anxiety, ADHD, and performance enhancement. Neurofeedback can lead to significant and lasting improvements in symptoms and functioning by normalizing abnormal brainwave patterns and connectivity.

  • Quantitative EEG (qEEG) allows patients to see localized electrical activity in their brains. This helps them understand the patterns underlying their difficulties and shift from self-blame to learning new processing.

  • Trauma can change brain waves in several ways:

  • Excessive suitable temporal lobe activity (fear center) and frontal slow waves, indicating an aroused emotional brain and poor executive functioning. Calming the fear center can help.

  • Hyperactivity when closing eyes, indicating panic without visual input. Training more relaxed brain patterns helps.

  • Overreaction to sounds/light, indicating thalamus that can't filter well. Changing communication at the back of the brain helps.

  • Combat exposure is associated with decreased alpha (relaxation) waves in the back of the brain and slowed front-of-the-brain activity, like in ADHD. This indicates chronic agitation and poor focus/executive functioning.

  • Neurofeedback can help reverse learning disabilities from childhood trauma by helping organize time/space processing and sensory integration that develops in early childhood.

  • Alpha-theta training uses neurofeedback to induce hypnagogic trance states. This can help loosen connections between trauma triggers and responses, reframe traumatic memories, and cultivate relaxation and new insights.

  • A study found that alpha-theta training significantly reduced PTSD and related symptoms in veterans compared to standard care. Benefits lasted over 2.5 years. The training facilitated trance states and cultivating positive imagery to reframe trauma.

  • In summary, neurofeedback shows promise for reducing hyperarousal, improving focus/executive functioning, remediating learning disabilities, reframing traumatic memories, and cultivating relaxation and insight. More research is needed, but findings suggest it could succeed where other interventions have yet to.

Some researchers have explored research on neurofeedback for addiction and PTSD, but it has received little mainstream attention. Studies show that 75-80% of patients in addiction treatment relapse. A study by Peniston and Kulkosky found that neurofeedback training for veterans with alcoholism and PTSD drastically reduced relapse over three years compared to standard treatment. Neurofeedback addresses the underlying hyperarousal involved in PTSD and addiction withdrawal. Questions remain about optimal neurofeedback protocols, but the paradigm is shifting to understand mental disorders in terms of brain rhythms and circuits. The director of NIMH has called for understanding mind and mental disorders in terms of the "connectome" - the interconnected networks in the brain.

  • The author initially attributed improvements in three veterans with PTSD to her therapy skills. She later learned their recovery was linked to participating in a play about homeless veterans that raised money for a shelter.

  • Theater has been used for communal coping and healing since ancient Greece. Greek plays likely helped reintegrate combat veterans and addressed traumatic stress. Modern programs use Greek plays to help today's veterans.

  • Collective movement and music create social bonding and meaning. Religious rituals, protest songs, and military drills use rhythm and movement. The Dutch rebels and Estonians used collective singing and protest to gain independence.

  • There is little research on how collective action affects the mind and alleviates trauma. However, the author has studied theater programs that treat trauma. They confront pain, involve symbolic transformation through community, and train people to access and share deep emotions.

  • Urban Improv in Boston does improvisational theater with at-risk youth. It inspired school programs and programs in residential centers.

  • The Possibility Project in New York City uses theater to help at-risk youth.

  • Shakespeare & Company in Massachusetts runs Shakespeare in the Courts for juvenile offenders.

  • These programs differ but share using theater and community to confront and transform the pain. Theater reflects the trauma people experience, and the programs help participants access and share complex emotions.

The key ideas are:

  1. Collective activity like theater, music, and movement creates social bonding and healing.

  2. Theater, in particular, has been used for centuries to help communities cope with painful topics, including war and trauma.

  3. Modern theater programs use this approach to help at-risk and traumatized groups, especially youth and veterans.

  4. These programs help participants access and share deep emotions through the symbolic transformation of trauma in a community context.

  5. While little studied, these programs suggest the potential for collective healing approaches.

• Traumatized people have difficulty experiencing and expressing emotions. Theater programs help them reconnect with their emotions and give voice to them.

• Trauma makes people feel cut off from others. The theater is a collective experience that helps forge connections between people.

• Traumatized individuals fear conflict and loss of control. Theater exposes them to conflict and helps them gain emotional regulation.

• Theater programs for traumatized groups go slowly to make participants feel safe. They use exercises to help people become more present, make eye contact, mirror each other, and build trust.

• Urban Improv is a theater program that aims to prevent violence. It uses improvisational skits to help students work through everyday problems and see how different choices might play out.

• A study found Urban Improv led to significant improvements in aggression, cooperation, and self-control in fourth graders. However, it did not have the same impact on eighth graders, likely because the older students had experienced much more trauma and violence.

• To be effective for highly traumatized groups, theater interventions must be more prolonged and intensive. Simply witnessing role plays is not enough. Participants need to become personally involved in the action.

The program focused on team building and emotion regulation for violent middle/high school students. Professional actors worked with psychologists to develop improvisational scripts depicting trauma experiences. At first, students sided with the aggressors in the scripts but gradually experimented with different roles, even showing vulnerability. A program to implement the curriculum in Boston schools failed, but it continues in residential treatment.

The Possibility Project has high school students write and perform an original musical over nine months. The program builds competence and relationships for foster care youth to counter feelings of abandonment and distrust. Sharing life stories and creating the production helps them express emotions, be heard, and support each other. Performing gives them a sense of control over their lives. The program teaches cause and effect in ways that their unpredictable lives do not.

Shakespeare in the Courts has adjudicated teen offenders who study and perform Shakespeare plays over six weeks. With no words for their emotions, these teens act out with violence. Shakespeare allows them to practice controlled aggression through stage combat and explore complex emotions. Memorizing and performing the challenging language of Shakespeare cultivates self-discipline and a sense of accomplishment. Seeing the impact of their expressions and actions on an audience teaches empathy. The program has reduced recidivism.

In summary, these theater-based programs give vulnerable and violent youth a means to build competence, relationships, self-control, and empathy. Performing helps them transform their experiences in a way that builds confidence from the inside out.

The key points are:

  1. The program uses the richness and power of language and physical expression to help at-risk kids discover themselves and gain skills. The emphasis is on safety, communication, and self-expression rather than physical power or violence.

  2. The director helps the kids slowly internalize Shakespeare's words by repeating the lines and focusing on their meaning and associations. This helps the kids discover and express emotion gradually. For some, this can be transformative.

  3. The program teaches the kids emotional awareness and specificity in talking about feelings. Instead of vague judgments like "good" or "bad," the kids learn to identify and name specific feelings like "angry" or "scared." This helps them gain emotional awareness and the ability to tolerate complicated feelings.

  4. Performing in front of others is challenging but helps build trust and confidence. Kids gain experience being vulnerable in a supported way.

  5. Theater and therapy are similar in relying on intuition, emotion, and subjective experience rather than objective research. A story demonstrates how unpacking emotional memories through theater exercises and performance can be powerfully healing.

  6. There is growing awareness of the impacts of trauma, as demonstrated by research and programs aiming to intervene and provide support. The potential benefits to individuals and society are enormous. Overall, the program shows how self-expression, community, and facing challenges in a supported way can help at-risk kids develop confidence, skills, and emotional awareness.

The key themes are: -The power of language, emotion, intuition, and subjective experience -The challenges and benefits of vulnerability and facing difficulties -The potential for growth, healing, and transformation with the proper support and opportunities for self-expression

Does this summary accurately reflect the key points and themes? Let me know if you want me to clarify or expand the summary further.

  • Advancements in neuroscience have given us a better understanding of how trauma changes the brain and impacts self-regulation, focus, and relationships. We now know how to treat and prevent trauma effectively.

  • However, trauma remains a significant public health issue, and its societal impacts seem to worsen in some ways, e.g., increasing domestic violence, poverty, lack of healthcare, etc. Trauma is linked to politics and social conditions. We need massive efforts to help people deal with trauma and its effects.

  • The author argues that we must recognize our shared humanity and interconnectedness to heal from collective trauma. As social creatures, we need nurturing relationships and community support. Many mental health approaches fail to provide this.

  • Our society must focus on children's needs and provide high-quality childcare, preschool, and family support. This could help address issues like lack of self-regulation, perseverance, concentration, and confidence that prevent people from reaching their potential.

  • Fear and lack of nurturing relationships inhibit growth, curiosity, and the ability to explore one's identity. Over half of Head Start children have experienced adverse childhood events contributing to drug use, obesity, and violence.

  • People who feel safe and connected are less likely to engage in self-destructive behaviors. Trauma is the most significant cause of mental health issues and substance abuse. We need to prevent child abuse and neglect to have a healthy society.

In summary, the key arguments are: We must recognize how trauma impacts society and politics. We need to understand shared humanity and provide nurturing relationships to heal. We should focus on children's needs and prevent childhood trauma from having a healthy, thriving population. Overall it is a call to action for societal change to address the root causes of trauma.

The author and her colleagues have developed programs to help traumatized children. They work with local organizations across the U.S. to implement these programs. For example, they worked with a Native American community in Montana to develop a culturally sensitive trauma program.

Schools can play an essential role in helping traumatized children. They can provide safety and stability and help children develop resilience and coping skills. However, many teachers struggle to handle the challenging behaviors of traumatized children. The author's team helps teach teachers about trauma and strategies to support these students better.

Some key strategies include:

•Recognizing that disturbing behaviors are often expressions of trauma. Punishment is ineffective and exacerbates the trauma.

•Providing stability and predictability. Clear expectations and consistency are essential.

•Helping children identify and express their emotions. They teach breathing exercises, yoga, and other techniques to help children regulate themselves.

•Having children look in a mirror to better recognize different emotions. They teach children how emotions relate to physical sensations and how to communicate their feelings.

•Creating safe spaces where children can calm down and self-soothe using sensory items like blankets, music, bubbles, etc. Before rejoining the group, the children discuss what upset them.

•Ensuring all school staff understands trauma and consistency greet, notice, and connect with the children. Checking in with children is essential.

• Discuss problems with children and come up with solutions together. This helps children feel heard and gives them a sense of control.

•Connecting with parents, when possible, to provide education and support. Avoiding calling parents if it may lead to further abuse.

The ultimate goals are helping children feel safe, improve emotional intelligence, strengthen self-regulation, and find their voice. With support, traumatized children can learn, thrive, and build healthy relationships.

• Teachers and clinicians can use simple interventions to help children develop skills to regulate their emotions and reactions. Mirroring exercises, improvisation, music, dance, theater, and athletics promote reciprocity, cohesion, and focusing abilities.

• These interventions give children experiences of succeeding at challenging tasks and a sense of agency that helps build resilience. Team activities and performances also engage children in new roles and collaborations that are opposite to the experiences of trauma.

• Studies show these interventions help reduce anxiety, aggression, withdrawal, and other symptoms in traumatized children. Although the children still face difficulties, they can better cope and seek help.

• Trauma often spurs societal advances as people work to prevent and address its impacts. Many leaders and visionaries have also overcome their own traumatic experiences.

• The criteria proposed for diagnosing Developmental Trauma Disorder aim to recognize the effects of chronic interpersonal trauma on children. Whether or not the children show symptoms that meet the criteria for PTSD, they deserve appropriate diagnosis and treatment.

• The interventions and proposed diagnosis draw on knowledge about the neurobiology of trauma and its transmission and the human capacity for resilience, joy, creativity, and connection. With the proper societal response, the impacts of trauma can be addressed.

• The work is challenging but rewarding. Success comes from understanding the sources of resilience and meaning that allow people to overcome suffering.

Here is a summary of the Consensus Proposed Criteria for Developmental Trauma Disorder:

  1. Exposure: The child has experienced or witnessed prolonged/multiple traumatic events over at least one year, including:
  • Direct interpersonal violence

  • Disruptions in caregiving (changes in caregiver, separation from a caregiver, emotional abuse)

  1. Affective and Physiological Dysregulation: Impaired ability to regulate emotions and bodily functions, manifesting in at least 2 of the following:
  • Inability to regulate extreme emotions (prolonged tantrums, immobilization)

  • Disturbances in bodily functions (sleeping, eating, sensitivity to touch/sound)

  • Diminished awareness of emotions/bodily states

  • Impaired ability to describe emotions/bodily states

  1. Attentional and Behavioral Dysregulation: Impaired ability to focus, learn, and cope with stress, manifesting in at least 3 of the following:
  • Preoccupation with threat or impaired perception of threat

  • Impaired self-protection (risk-taking, thrill-seeking)

  • Maladaptive self-soothing (rocking, masturbation)

  • Self-harm (intentional or reactive)

  • Inability to start or continue goal-directed behavior

  1. Self and Relational Dysregulation: Impaired sense of Self and ability to relate to others, manifesting in at least 3 of the following:
  • Preoccupation with caregiver's safety or difficulty with reunions after separation

  • Negative self-perception (self-loathing, helplessness, worthlessness)

  • Extreme distrust in relationships or lack of reciprocity

  • Aggression toward others (physical/verbal)

  • Inappropriate attempts to get intimacy or reliance on others for safety

  • Lack of empathy for others' distress or exaggerated responsiveness to others' distress

  1. Posttraumatic Spectrum Symptoms: At least one symptom in 2 of 3 PTSD symptom clusters (reexperiencing, avoidance, hyperarousal)

  2. Duration: Symptoms last at least six months

  3. Impairment: Clinically significant distress/impairment in at least two areas (school, family, peers, health, legal, work)

In summary, this proposed diagnosis aims to characterize the effects of chronic interpersonal trauma and disrupted attachment during childhood, which the current PTSD diagnosis does not fully capture.

Several programs use improvisational theater, yoga, and mindfulness to help traumatized youth. These include:

  • Urban Improv: Uses improv workshops to teach violence prevention and conflict resolution skills.

  • The Possibility Project: Based in NYC, it helps at-risk youth.

  • Shakespeare in the Courts: Helps teens in juvenile detention centers.

  • Give Back Yoga Foundation and Kripalu Center provide yoga for trauma victims.

  • Mind and Life Institute studies mindfulness and psychology.

Further reading recommendations on:

  • Dealing with traumatized children: covers treatment models, developing resilience and competency.

  • Psychotherapy approaches like mindfulness, attachment, and neuroscience.

  • The neuroscience of trauma: how it impacts the body and brain.

  • Body-oriented approaches to healing trauma like yoga and sensorimotor therapy.

  • EMDR therapy: processes traumatic memories.

  • Working with dissociation from trauma.

  • How trauma impacts relationships and couples therapy.

  • Yoga and mindfulness for trauma.

  • Neurofeedback: training brainwave activity.

  • How trauma manifests in physical illness.

  • Meditation and mindfulness practices.

  • Psychomotor Therapy: mind-body approach.

The notes refer to studies showing the impact of trauma, from the Adverse Childhood Experiences study to trauma in war veterans to child abuse statistics.

The summary covers some critical takeaways around the programs, readings, and research in psychotherapy, neuroscience, and body-based practices to heal from trauma. However, it leaves out many of the specifics and details that would be in the whole passage. The assistant aims to give a high-level sense of the resources and topics covered, but reviewing the complete material would be needed for depth and nuance.

Here is a summary of key points about the BRAIN:

  1. The brain has two main parts: the instinctual "reptilian brain" that controls arousal, survival, and bodily functions, and the cognitive "mammalian brain" that governs higher reasoning and executive functions.

  2. Trauma activates the amygdala in the reptilian brain, which triggers a "fight, flight, or freeze" response. This can override the mammalian brain and cause a person to feel out of control.

  3. The amygdala encodes emotional memories and reactions, especially fear responses. It reacts to perceived threats before the cognitive brain can contextualize the situation.

  4. The hippocampus is essential for conscious memory and learning. Trauma can impair the hippocampus, making it difficult to remember and learn from traumatic experiences in a helpful way.

  5. The prefrontal cortex governs reasoning, planning, logic and executive functioning. Trauma exposure can inhibit the prefrontal cortex, making it hard to control emotions and impulses. However, the prefrontal cortex can exert more control over the amygdala with treatment.

  6. Mirror neurons help us understand the intentions and emotions of others. Dysfunction in the mirror neuron system may contribute to the social and emotional issues that sometimes arise from trauma exposure.

  7. States become traits as neural pathways are reinforced. The brain is "plastic" and adapts based on life experiences. However, even entrenched patterns can be modified with a conscious effort by developing new neural pathways. Treatment aims to shift trauma reactions from "state" to "trait."

  8. Medications and therapy work in different ways. Medications target neural pathways chemically, while therapy uses neural networks to build new associations and ways of thinking. A combination of both is often most effective for trauma recovery.

  9. The brain can continue to change and heal, even in adulthood. While early childhood experiences shape brain development, the brain maintains some plasticity across the lifespan. Trauma is not necessarily "hardwired." New experiences, learning, and growth can transform trauma's effects on the brain.

The authors review research on mirror neurons and neural pathways involved in emotional contagion and empathy. Mirror neurons activate when we observe another person performing an action or expressing an emotion. This activation lets us understand the other person's mental state and feelings. The perception-action model proposes that understanding another's emotion involves imitating their expression and posture, eliciting a corresponding feeling in ourselves.

The anterior insula and anterior cingulate cortex are involved in empathy and self-awareness. The default mode network, particularly the medial prefrontal cortex, is involved in self-referential thought and autobiographical memory. Difficulty regulating the connection between the anterior insula and medial prefrontal cortex may contribute to empathetic distress and burnout.

Trauma can alter the amygdala, hippocampus, and ventromedial prefrontal cortex functions, disrupting emotion regulation, integration of thoughts and feelings, and self-coherence. This can lead to depersonalization, where one feels detached from one's thoughts, feelings, and body. Early traumatic experiences are linked to long-term changes in the body and brain due to epigenetics and developmental neuroplasticity. Somatosensory, body-based therapies may help to restore self-awareness and emotion regulation.

The polyvagal theory proposes a psycho-physiological model connecting trauma, emotion regulation, and autonomic nervous system function. The ventral vagal complex, linked to social communication, can become deactivated in response to trauma, while the sympathetic nervous system becomes overactivated. Learning to reactivate the ventral vagal complex through exercise, meditation, music, and therapy can help to restore calmness, social connection, and well-being.

In summary, our experience of emotions, identity, and mental coherence relies on awareness and integration of neural signals from our body and connections between multiple brain networks. Trauma can disrupt these connections and processes, causing a loss of emotional, empathetic, and bodily awareness that contributes to distress and disconnection from Self and others. Therapies targeting the body and nervous system function may restore integration and well-being.

Here is a summary of the key points from the sources:

• Dissociation and dissociative disorders are caused by exposure to traumatic events, especially during childhood. Dissociation disrupts the usually integrated functions of consciousness, memory, identity, emotion, perception, body representation, and behavior. Dissociative disorders include dissociative identity disorder, dissociative amnesia, and depersonalization disorder.

• The brain stem and related structures regulate consciousness, arousal, and the bodily state. Dissociation may be linked to dysregulation in these systems.

• Traumatic experiences can affect brain functioning, health, personality, and cognitive capacities. Exposure to interpersonal violence as a child is particularly damaging.

• Sensorimotor approaches to treatment focus on reconnecting the mind and the body. They aim to help people reconnect with their physical experiences and sensations to overcome the effects of trauma.

• Alexithymia refers to difficulties identifying and describing emotions. It is common in PTSD and linked to problems recognizing emotions in oneself and others. It may make it harder to process traumatic memories.

• Re-victimization and poly-victimization, exposure to multiple traumatic events, increase the risk of PTSD, depression, substance abuse, delinquency, and other problems.

• Depersonalization refers to feeling detached from one's thoughts, feelings, and body. It is a dissociative symptom linked to trauma exposure.

• Secure attachment relationships in infancy lead to healthier psychosocial development. Insecure and disorganized attachments are linked to higher risks of trauma-related disorders.

• Healthy development depends on attunement and the capacity to share emotional states with others. Trauma undermines attunement, as it overwhelms the ability to feel emotionally connected. Treatment aims to rebuild attunement and emotional regulation.

• Sense of inner reality is necessary for psychological health and relationships. It arises from attunement with caregivers and ongoing connections between mind and body. Trauma disrupts this, while treatment works to restore it.

The author discusses how early attachment relationships shape a child's developing Self. Children who experience abuse and neglect often develop disorganized attachments that leave them feeling helpless and fearful in relationships. These early experiences become internalized and shape the child's sense of Self and expectations of relationships.

The author describes how frightening and helpless relationships in childhood can alter the developing stress response systems and the integration of the mind and body. This can manifest in symptoms like dissociation as a way to cope with fearful experiences that feel inescapable. Disorganized attachment is linked to more severe trauma symptoms, emotional dysregulation, aggression, and borderline symptoms in adulthood.

The author argues that the traumatized child can become trapped reenacting frightening relationship dynamics from childhood with caregivers who were supposed to provide safety and comfort. These dynamics often persist into adulthood through unconsciously repeating familiar but dysfunctional relationship patterns. Escaping this "traumatic servitude" requires awareness of these dynamics, processing the emotional pain they have caused, and accessing relationships where one feels unconditionally safe, seen, and soothed.

The summary outlines how childhood abuse, neglect, and disorganized attachment can have lifelong impacts by altering biological and psychological development. Early experiences shape a view of relationships as frightening and inescapable, leading to the repetition of trauma dynamics across relationships and even generations. Healing requires awareness of these dynamics, processing the painful emotions they evoke, and cultivating new relationships where one feels safe and cared for.

  1. When people have out-of-body experiences, brain imaging shows increased activity in the superior temporal cortex. This area is involved in self-processing and perceiving one's own body.

  2. Child sexual abuse creates a confusing dilemma for the victim, who has to choose between disclosing the abuse and betraying the perpetrator (often someone they depend on) or staying silent and remaining vulnerable. This was first described by Sándor Ferenczi in 1933.

  3. The Diagnostic and Statistical Manual of Mental Disorders (DSM) provides standard criteria for diagnosing mental disorders. Diagnoses involve identifying clusters of symptoms that tend to co-occur.

  4. Early trauma has been shown to alter the development of the orbitofrontal cortex and precuneus in the brain, areas involved in self-regulation, decision making, and perspective-taking.

  5. A study of Adverse Childhood Experiences (ACE) found a strong dose-response relationship between early adversity and poor health and social outcomes. As the number of ACEs increased, so did the risks for numerous medical and social problems.

  6. Early neglect and abuse have been shown to alter the development of opioid receptors in the anterior cingulate cortex in animals. This area is involved in affiliation, security, and emotion regulation. Lack of mothering in infancy may have lifelong impacts on bonding and relationships.

  7. Complex posttraumatic stress disorder (CPTSD) was proposed to diagnose the cluster of symptoms seen in survivors of prolonged, repeated trauma, especially in childhood. These include problems with emotional regulation, dissociation, somatic distress, and disrupted relationships.

  8. The diagnosis of CPTSD was considered for inclusion in the DSM-5 but ultimately was not included, despite significant research supporting it. It remains a widely used diagnosis, especially for survivors of childhood trauma.

  9. Disorders of extreme stress (DESNOS) was an early term for the cluster of symptoms now described as CPTSD. The name was changed to avoid confusion with "stress disorders."

  10. Research shows that a history of childhood trauma predicts poorer outcomes and higher relapse rates among patients treated for depression. Early adversity may alter neurobiology, making it harder to treat mood disorders.

  11. Witnessing domestic violence as a child can be psychologically and socially damaging over the long run. It is a form of trauma that disrupts a sense of safety and security during development.

Here are the key points from the referenced research:

• Exposure to adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, has been linked to adverse health and social outcomes later in life.

• There are complex relationships between genetics, environment, and development. Both nature and nurture shape outcomes. Genetics provides a blueprint, but the environment influences how those genetics are expressed.

• Early adversity can cause "developmental cascades," negatively impacting other domains of development and functioning over time.

• Exposure to complex trauma in childhood is associated with higher risks of PTSD, health problems, cognitive problems, attachment problems, and other issues.

• The proposed diagnosis of Developmental Trauma Disorder aims to capture the impacts of exposure to complex trauma in childhood. It recognizes that complex trauma can cause impairments in emotional, behavioral, cognitive, and social functioning.

• Longitudinal research following children has found that early experiences of abuse, neglect, loss of a caregiver, or a chaotic home environment can predict outcomes decades later, including mental health issues, health issues, and social problems. Things like disorganized attachment and role reversal with caregivers at a young age predict poor outcomes later.

• Both environment and genetics influence the development of psychopathology. For example, particular genes interacting with childhood maltreatment may increase risks for PTSD, suicide attempts, alcohol dependence, and other problems.

• Animal research also shows how early experiences can influence the expression of genes and the developing brain. This provides a model for understanding how the same may happen in humans.

That covers the key highlights from the research discussed in the chapter on developmental trauma. Please let me know if you want me to clarify or expand upon any part of this summary.

  • Children who experience physical abuse have triple the risk of conduct disorder or oppositional defiant disorder. Neglect or sexual abuse doubles the risk of anxiety disorders. Unavailable parents or sexual abuse doubles the risk of later PTSD. The risk of multiple disorders is 54% for neglect, 60% for physical abuse, and 73% for sexual abuse.

  • A 40-year study of 698 people in Kauai, Hawaii, showed that those from unstable homes often had problems with behavior, health, and relationships. However, one-third showed resilience, developing into caring and confident adults, often with the help of non-parental caretakers or community groups.

  • A disruptive mood dysregulation disorder study did not consider attachment, trauma, abuse, or neglect. The DSM only briefly mentions "maltreatment."

  • The DSM, a bestseller, is a significant source of income for the American Psychiatric Association. Critics argue that it lacks scientific validity. The NIMH is developing alternative criteria.

  • Studies show that early intervention for disadvantaged children has long-term benefits. Programs like child home visitation, psychotherapy for abuse/trauma survivors, and prevention programs can be beneficial.

  • Traumatic memories are often vivid but disorganized. Stress hormones enhance emotional memory consolidation in the amygdala but impair the prefrontal cortex, disrupting verbal memory. The thalamus and medial prefrontal cortex also are involved in trauma memory.

  • Dissociation, a disruption in customarily integrated consciousness, memory, identity, and perception functions, is ordinary in trauma survivors. It can produce fragmented or repressed memories that feel surreal. The idea of a traumatic memory as "hysterical" has been debunked. Most trauma memories are based on actual events, though they may be distorted or misplaced in time.

  • The research shows the complex neurobiology of trauma and memory. Traumatic memory is a collaborative effort between many parts of the brain, not simply a matter of being "repressed" or "fabricated."

  • The concept of the unconscious mind originated in the late 19th century with thinkers such as Pierre Janet and Sigmund Freud. They posited that mental processes outside our awareness influence our thoughts, feelings, and behaviors.

  • The massive psychological trauma of World War I led to increased interest in understanding traumatic disorders of the mind. The British physician Charles Myers coined the term "shell shock" to describe the atypical reactions of soldiers to war trauma.

  • Increasing recognition of the long-term impact of trauma led to the concept of "posttraumatic stress disorder" (PTSD) in the 1970s. PTSD became an official psychiatric diagnosis in 1980.

  • The nature of traumatic memories has been controversial. Some argued that traumatic memories could be "repressed" and recovered later, while others argued that memory is susceptible to distortion and "false memories." There is evidence that trauma memories can be forgotten and recovered, but memory can also be unreliable.

  • The ideas of PTSD and repressed memory were influential but controversial. They shaped our modern understanding of psychological trauma and its effects.

The critical sources for these ideas were Pierre Janet, Sigmund Freud, World War I physicians, and Abram Kardiner. The controversies around repressed memory involved Elizabeth Loftus and proponents of the recovered memory movement.

Augmenting Traditional Treatment for Children with Disabilities," thesis, Montana State University, 2010.

  1. R. A. Lanius, "Restoring a Sense of Safety: A key to Treatment Success," in Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society (New York: Guilford Press, 2006), 368–79.

  2. S. Segal, "The Roots of Consciousness: How the Embodied Self Regulates the Brain-Body Loop," Annals of the New York Academy of Sciences 1296, no. 1 (2013): 72–79. See also A. Bechara, H. Damasio, and A. R. Damasio, "Emotion, Decision Making, and the Orbitofrontal Cortex," Cerebral Cortex 10 (2000): 295–307; K. N. Ochsner et al., "For Better or For Worse: Neural Systems Supporting the Cognitive Down- and Up-Regulation of Negative Emotion," NeuroImage 23 (2004): 483–99; and L. Singer and L. Sinatra, "Nourishing the Mind," chapter 11 in The Healing Power of Emotion, ed. D. Fosha, D. Siegel, and M. Solomon (New York: Norton, 2009), 230–50.

  3. Siegal et al. (2009) 229

  4. R. Sapolsky, Why Zebras Do not Get Ulcers (New York: Holt Paperbacks, 2004); N. Heller and L. LaPierre, Healing Developmental Trauma: How Early Trauma Affects Self-Regulation, Self-Image, and the Capacity for Relationship (Berkeley: North Atlantic Books, 2013).

  5. Porges (2010). See also S. W. Porges, "Orienting in a Defensive World: Mammalian Modifications of Our Evolutionary Heritage. A Polyvagal Theory," Psychophysiology 32, no. 4 (1995): 301–18; and S. W. Porges, "The Polyvagal Theory: New Insights into Adaptive Reactions of the Autonomic Nervous System," Cleveland Clinic Journal of Medicine 76, suppl. 2 (2009): S86–S90.

  6. Sapolsky (2004).

  7. Damasio's research has shown how bodily experience and emotion are essential for rational thought and decision making. See A. Damasio, Descartes' Error: Emotion, Reason, and the Human Brain (New York: G. P. Putnam's Sons, 1994).

  8. R. Schore, Affect Regulation and the Repair of the Self (New York: WW Norton, 2003).

  9. J. Bowlby, A Secure Base: Parent-Child Attachment and Healthy Human Development (New York: Basic Books, 1988).

  10. M. A. Van Ijzendoorn, C. Schuengel, and M. H. Bakermans-Kranenburg, "Disorganized Attachment in Early Childhood: Meta-Analysis of Precursors, Concomitants, and Sequelae," Development and Psychopathology 11, no.2 (1999): 225–49.

  11. D. J. Siegel, The Developing Mind, 2nd ed.: How Relationships and the Brain Interact to Shape Who We Are (New York: Guilford Press, 2015).

  12. Schore (2003); Schore (2001). Schore summarizes the neuroscience research showing how secure attachment relationships impact development.

  13. The neuroscientist Stephen Porges proposed the polyvagal theory, demonstrating how ventral vagal myelinated pathways support social engagement and calmness. See Porges (2001, 2009, 2010).

  14. Schore (2001, 2003).

  15. "Insecurely attached individuals often experience emotional distress or anxiety in interpersonal situations because they have not developed effective strategies for regulating negative emotions," says Schore (2003, 27).

  16. M. H. Teicher, "Wounds That Time Will not Heal: The Neurobiology of Child Abuse," Cerebrum 2, no. 4 (2000): 50–67. The Adverse Childhood Experiences (ACE) Study is one of the most extensive investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. It found a robust relationship between emotional, physical, and sexual abuse in childhood and risks for several leading causes of death in adults: "The stronger the childhood exposure to abuse, the higher the likelihood of heart disease, cancer, chronic lung, and liver disease." The dose-response relationship between the number of categories of childhood exposure and multiple forms of adult pathology persisted even after controlling for known risk factors such as smoking, obesity, and other causes of death.

  17. See B. Perry et al., "Childhood Trauma, the Neurobiology of Adaptation and 'Use-Dependent' Development of the Brain: How 'States' Become 'Traits,' Infant Mental Health Journal 16, no. 4 (1995): 271–91. See also Shore (2003); M. H. Teicher, C. M. Anderson, and A. Pollak, "Pre-Pubertal Stress Exposure Interacts with Puberty to Influence Hippocampal Volume in Adolescent Girls: A Prospective Study.," Psychophysiology 55, no. 6 (2018): e13039.

  18. J. Bowlby, Attachment and Loss, Vol. 1: Attachment (New York: Basic Books, 1980).

  19. Bowlby (1988). See also M. D. Main, N. Kaplan, and J. Cassidy, "Security in Infancy, Childhood, and Adulthood: A Move to the Level of Representation," in Growing Points of Attachment Theory and Research. Ed. I. Bretherton and E. Waters (Monographs of the Society for Research in Child Development) (Chicago: University of Chicago Press, 1985), 1, 66–104.

  20. In particular, they develop "internal working models" of Self and others, which Bowlby described as "cognitive frameworks comprising memories, beliefs, and expectations about the self and attachment figures and the relationships between them." Bowlby (1988), 81.

  21. Main et al. (1985) presents the "dismissed state of mind" in the attachment.

  22. M. Hesse and M. Main, "Frightened, Threatening, and Dissociative Parental Behavior in Low-Risk Samples: Description, Discussion, and Interpretations," Development and Psychopathology 18, no. 2 (2006): 309–343.

  23. Schore (2003) details how insecure attachment in infancy impacts proper brain development and the capacity to regulate effect and adapt to stress.

  24. B. Perry and M. Szalavitz, The Boy Who Was Raised as a Dog: And Other Stories from a Child Psychiatrist's Notebook: What Traumatized Children Can Teach Us About Loss, Love, and Healing (New York: Basic Books, 2006).

  25. B. D. Perry and R. Pollard, "Altered Brain Development Following Global Neglect in Early Childhood," Society for Neuroscience: Proceedings from Annual Meeting (New Orleans, LA: Society for Neuroscience) 23, no. 972 (1997).

  26. A. N. Schore, The Science of the Art of Psychotherapy (New York: WW Norton, 2012).

  27. M. F. Solomon and D. J. Siegel, Healing Trauma: Attachment, Mind, Body and Brain, ed. M. F. Solomon and D. J. Siegel (New York: WW Norton, 2003).

  28. M. Balbernie, "Circuits and circumstances: The neurobiological consequences of early relationship experiences and how they shape later behavior," Journal of Child Psychotherapy 27:23–2, 2009, 237–55. DOI: 10.1080/00754170601187

Here is a summary of the two sources:

Source 1: E. Warner et al., "Can the Body Change the Score?" Journal of Family Violence 28, 7 (2013): 729-38.

  • The study examines the use of sensory modulation techniques in the residential treatment of traumatized adolescents.

  • Sensory modulation focuses on regulating arousal and avoiding triggers. Techniques include yoga, massage, music, and weighted blankets.

  • Study found reductions in PTSD and behavioral issues, as well as improved emotion regulation and interpersonal skills.

  • Suggests that sensory modulation should be integrated into standard treatment for traumatized youth.

Source 2: A. Fine, Handbook on Animal Assisted Therapy (2010).

  • Provides an overview of animal-assisted therapy (AAT), in which animals are used to provide affection and comfort to patients.

  • AAT is used for PTSD, trauma, anxiety, depression, and relationship issues. Interacting with animals can decrease stress and ease anxiety.

  • Guidelines are provided for the effective and ethical implementation of AAT. Proper training, health, and safety standards for animals and handlers are emphasized.

  • Research shows that AAT decreases PTSD symptoms, anxiety, and depression, as well as improved self-esteem, socialization, and quality of life.

  • The human-animal bond can activate the release of oxytocin, decrease blood pressure and heart rate, and increase positive social interaction and mood.

The sources present two complementary therapeutic approaches for treating trauma and PTSD: sensory modulation techniques focused on regulating arousal and avoiding triggers and animal-assisted therapy to decrease anxiety and stress through bonding with companion animals. Research supports the effectiveness of both methods in alleviating symptoms and improving functioning.

Here is a summary of the research study:

  • The study examined the efficacy of topiramate versus placebo in reducing PTSD symptoms in civilians with chronic PTSD.

  • Sixty participants were randomized to receive either topiramate (n=30) or placebo (n=30) for eight weeks.

  • Topiramate dosage was titrated up to 200 mg/day. Patients were assessed at baseline and weeks 1, 2, 4, and 8 using the Clinician-Administered PTSD Scale (CAPS), PTSD Checklist (PCL), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A).

  • Results: At the end of week 8, patients in the topiramate group had significantly more significant improvement in PTSD symptoms compared with the placebo group as measured by the CAPS and PCL. Topiramate treatment was also associated with more significant reductions in depression and anxiety symptoms.

  • Conclusions: Topiramate was superior to placebo in reducing PTSD, depression, and anxiety symptoms. The authors propose that topiramate may be an effective treatment for PTSD in civilian populations.

  • Comments: This randomized placebo-controlled trial provides evidence for the potential efficacy of topiramate, an anticonvulsant, in reducing symptoms of chronic PTSD and related comorbidities like depression and anxiety. The results are promising but limited by the small sample size and short duration. More extensive replication studies with more prolonged treatment and follow-up periods are needed.

  • The frontal lobe area involved in self-awareness and regulating the brain's fear center, the amygdala, was impaired in people with PTSD.

  • This made it harder for them to suppress fear responses and distract themselves, affecting their daily functioning.

  • Multiple studies show that PTSD involves abnormal activation patterns in working memory and attention networks.

  • Eye movement desensitization reprocessing (EMDR) therapy helps process traumatic memories and reduce their impact.

  • EMDR involves recalling distressing events while performing eye movements or other bilateral stimulation, which helps transform the memory.

  • This is thought to work by mimicking the effects of rapid eye movement (REM) sleep, which is important for memory consolidation and processing emotional information.

  • Yoga and other practices that increase body awareness and relaxation can help supplement treatment. They may work by stimulating the parasympathetic nervous system and balancing the autonomic nervous system.

The study examined heart rate responses in trauma survivors following a traumatic event. It found that increased heart rate in response to script-driven imagery of the traumatic event was associated with a higher risk of subsequently developing posttraumatic stress disorder (PTSD). Survivors who showed a blunted heart rate response were less likely to develop PTSD.

The researchers suggest that the heart rate response may indicate how strongly the traumatic memory is encoded and how readily it can be activated. Heightened physiological responses may strengthen the encoding and connectivity of the traumatic memory, increasing the risk of reexperiencing symptoms and PTSD. Blunted responses may lead to poorer encoding and less activation of the traumatic memory, reducing PTSD risk.

The researchers propose that the heart rate response could help identify people at high risk of PTSD following trauma exposure and target them for early intervention. Treatments aimed at regulating arousal and making the traumatic memory less emotionally activating may help prevent the development of PTSD.

The findings highlight the importance of arousal, emotional activation, and physiological responses in the development and experience of PTSD symptoms. Approaches such as yoga, meditation, controlled breathing, and biofeedback, which can help regulate arousal and modify emotional and physiological responses, may be helpful in the prevention and treatment of PTSD. More research is needed, but preliminary evidence suggests these complementary approaches hold promise.

In summary, this study found that heart rate responses during recollection of a traumatic event were linked to the risk of subsequently developing PTSD. Heightened responses were associated with greater risk, while blunted responses were associated with lower risk. The findings highlight the potential value of arousal regulation techniques for preventing and reducing PTSD symptoms.

Here is a summary of the key points:

• E. R. Nijenhuis and K. Steele (2006) describe how early chronic trauma can lead to a dissociated sense of Self, or "structural dissociation." Kluft (2013) describes how this can be healed through a phased approach in therapy.

• Richard Schwartz (1995) developed Internal Family Systems therapy, which conceptualizes the mind as containing different "parts" in conflict or harmony. Therapy involves identifying and understanding these parts, reducing polarization, and finding harmony.

• Imagery, metaphors, and personifying parts can help understand and work with them. The "Self" is the grounded, calm part that can connect with all other parts.

• Cognitive behavioral therapies, mindfulness, and relaxation techniques have been shown to help reduce symptoms in people with autoimmune disorders and PTSD. Neurofeedback is a method of brain training that can also help rebalance the brain, reducing symptoms of conditions like epilepsy, ADHD, PTSD, and others.

• Neurofeedback trains the brain through operant conditioning, providing rewards (feedback) for producing specific EEG frequencies and patterns. It has been shown to activate underactive areas and calm overactive areas of the brain. It can enhance performance in normal individuals and is effective for PTSD, ADHD, epilepsy, and other disorders.

• Quantitative EEG (qEEG) can map a person's brainwave patterns and identify abnormalities. qEEG-guided neurofeedback uses this information to target specific areas for training.

• Slow cortical potentials are very slow EEG waves that represent shifts in cortical excitability. Neurofeedback focused on them is effective for ADHD. Other approaches focus on posterior alpha waves (calming), sensorimotor rhythm (SMR; focused attention), beta waves (alertness), and frontal midline theta (relaxed, meditative).

• The effects of neurofeedback seem to rely on operant conditioning to strengthen neural connections and produce a balanced, resilient autonomic nervous system and increased connectivity between the prefrontal cortex, cingulate, limbic system, and basal ganglia.


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